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Romagnoli G, D'Alessandris QG, Capone I, Tavilla A, Canini I, Lapenta C, Buccarelli M, Giordano M, Tirelli V, Sanchez M, Fragale A, Giannetti S, Di Bonaventura R, Lauretti L, Biffoni M, Ricci-Vitiani L, Pallini R, Gabriele L. CD8+CD103+PD1+TIM3+ T cells in glioblastoma microenvironment correlate with prognosis. Immunology 2024; 171:198-211. [PMID: 37884280 DOI: 10.1111/imm.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
Glioblastoma, isocitrate dehydrogenase-wildtype (GB), is the most common and aggressive primary brain malignancy with poor outcome. Immune checkpoint inhibitors (ICIs) have been tested in GB and, despite disappointing results, the identification of a small subgroup of responders underlies the need to improve our understanding of the tumour microenvironment (TME) immunity. This study aimed to determine whether the expression of selected immune checkpoints on tissue-resident memory T cells (Trm) may predict patient outcome. We conducted a single cohort observational study. Tumour samples were collected from 45 patients with histologically confirmed GB (WHO grade 4) and processed to obtain single-cell suspensions. Patients were assessed for the correlation of Trm phenotype with overall survival (OS) or progression-free survival (PFS) using multiparametric flow cytometry and uni/multivariate analyses. Levels of Trm expressing programmed cell death protein 1 (PD1) and T cell immunoglobulin and mucin domain-containing protein 3 (TIM3) were found to be linked to clinical outcome. Low frequency of Trm expressing PD1 or TIM3 or both markers defined subgroups as independent positive prognostic factors for patient survival. On multivariate analysis, low CD8+CD103+PD1+TIM3+ Trm and Karnofsky performance status (KPS) ≥70 were confirmed to be the most predictive independent factors associated with longer OS (hazard ratios-HR [95%CI]: 0.14 [0.04-0.52] p < 0.001, 0.39 [0.16-0.96] p = 0.04, respectively). The CD8+CD103+ Trm subgroups were also age-related predictors for survival in GB.
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Affiliation(s)
- Giulia Romagnoli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Imerio Capone
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Tavilla
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Irene Canini
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Lapenta
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Mariachiara Buccarelli
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Giordano
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Alessandra Fragale
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Giannetti
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Liverana Lauretti
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mauro Biffoni
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Ricci-Vitiani
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Pallini
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Gabriele
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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Xiao Z, Wu H, Chen X, Chen X, Yu R, Chen A. Herpes Zoster Ophthalmicus Clinical Presentation and Risk Factors for Lesion Recovery. Clin Cosmet Investig Dermatol 2023; 16:3767-3773. [PMID: 38170070 PMCID: PMC10759815 DOI: 10.2147/ccid.s444766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
Purpose Herpes zoster ophthalmicus (HZO) causes trouble in patients' daily life and work. In severe cases, it may even lead to a decrease or loss of vision. To understand the demographic information and ocular symptoms of hospitalized patients with HZO, and to find potential factors related to improvement time of skin rash and duration of ocular symptoms at discharge, we design this study. Patients and Methods This is a retrospective study. All patients diagnosed with HZO who were hospitalized in the Department of Dermatology of a hospital in Chongqing, China from January 1, 2015 to December 30, 2021 were included in this study. A total of 189 patients were included in this study. Clinical manifestations of the disease during hospitalization, improvement time of ocular skin lesions, and whether ocular skin lesions disappeared completely at discharge were recorded. Results The most common ocular symptom was eyelid swelling (92.6%), followed by eye pain (48.7%). The most common ocular sign was conjunctivitis (78.3%), followed by keratitis (15.9%). There were 149 cases without residual ocular symptoms and 40 cases with residual ocular symptoms. There was no statistically significant difference in demographic characteristics between the two groups (P>0.05). Age ≥70 years (B=0.381, -0.061~0.022, P=0.005), use of glucocorticoids (B=0.260, 0.024~0.496, P=0.031), and use of topical antiviral drugs (B=0.380, 0.054~0.705, P=0.023) were factors affecting the time interval from admission to improvement of skin rash. Tearing (HR, OR=4.827, 1.956~11.909, P<0.001) and blood urea nitrogen (OR=0.787, 0.620-1.000, P=0.050) were factors influencing residual ocular symptoms. Conclusion This study could help clinicians gain a deeper understanding of the clinical manifestations and partial influencing factors of HZO patients, which may contribute to future clinical work.
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Affiliation(s)
- Zupeng Xiao
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hanyi Wu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xin Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiaoli Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Rentao Yu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Aijun Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Hryzhak I, Pryshliak O, Kobryn T, Fedorov S, Boichuk O, Marynchak O, Kvasniuk V, Protsyk A, Miziuk R, Kucher A, Simchych M, Hryzhak L, Kuravkin M. Clinical and echocardiographic findings in patients with COVID-19 across different severity levels. J Med Life 2023; 16:1692-1700. [PMID: 38406777 PMCID: PMC10893567 DOI: 10.25122/jml-2023-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/08/2023] [Indexed: 02/27/2024] Open
Abstract
Cardiovascular pathology can complicate the course of COVID-19. The study aimed to identify echocardiographic abnormalities and key prognostic factors influencing severe and fatal COVID-19 outcomes. This retrospective cohort study included clinical and echocardiogram data from 194 medical records of hospitalized patients with COVID-19: 100 moderate cases, 34 severe cases with favorable outcomes, and 60 severe cases with fatal outcomes. Severe patients with favorable outcomes had greater reductions in left ventricular systolic fraction of left ventricle compared to moderate cases (23.5% vs. 7.0%, respectively, p=0.008) and ejection fraction of left ventricle (14.7% vs. 3.0%, respectively, p=0.013), grade I diastolic dysfunction of the left ventricle (20.6% vs. 8.0%, respectively, p=0.044), and pulmonary hypertension (29.41% vs. 10.0%, respectively, p=0.006). Patients with fatal outcomes had a mean age of 67.1±1.51 years, chronic heart failure functional class II (58.3%), hypertension (50.0%), type 2 diabetes (43.3%), and obesity (33.3%). Compared to severe cases but with favorable outcomes, fatal cases had a greater decrease in left ventricular ejection fraction (36.7% vs. 14.7%, respectively, p=0.024), various types of myocardial dysfunction (51.7% vs. 29.4%, respectively, p=0.037) and a trend towards increased pulmonary hypertension (48.3% vs. 29.4%, respectively, p=0.074). Consequently, chronic heart failure class II, reduced left ventricular ejection fraction, various myocardial dysfunctions, and pulmonary hypertension emerged as key cardiac risk factors for severe disease progression and mortality in patients with COVID-19.
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Affiliation(s)
- Ihor Hryzhak
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oleksandra Pryshliak
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Taras Kobryn
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Sergiy Fedorov
- Department of Therapy, Family and Emergency Medicines of Postgraduate Education, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oleksandr Boichuk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Oleksandra Marynchak
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Viktoriia Kvasniuk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Andrii Protsyk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Ruslan Miziuk
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Andrii Kucher
- Department of Airborne Infections of Communal Non-Commercial Enterprise, Ivano-Frankivsk Phthisiatry-Pulmonology Center, Ivano-Frankivsk, Ukraine
| | - Marianna Simchych
- Department of Airborne Infections of Communal Non-Commercial Enterprise, Ivano-Frankivsk Phthisiatry-Pulmonology Center, Ivano-Frankivsk, Ukraine
| | - Lilia Hryzhak
- Department of Airborne Infections of Communal Non-Commercial Enterprise, Ivano-Frankivsk Phthisiatry-Pulmonology Center, Ivano-Frankivsk, Ukraine
| | - Mariia Kuravkin
- Infectious Diseases and Epidemiology Department, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
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Kattner S, Sutharsan S, Berger MM, Limmer A, Jehn LB, Herbstreit F, Brenner T, Taube C, Bonella F. Serum KL-6 as a Candidate Predictor of Outcome in Patients with SARS-CoV-2 Pneumonia. J Clin Med 2023; 12:6772. [PMID: 37959236 PMCID: PMC10648641 DOI: 10.3390/jcm12216772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-infection is associated with an extremely variable disease course. When interstitial pneumonia (IP) occurs, it can lead to acute respiratory distress syndrome and death. Serum Krebs von den Lungen-6 (KL-6) is an established marker of IP, but its role as a marker of SARS-CoV-2 pneumonia is debated. This bicentric study included 157 patients with SARS-CoV-2 pneumonia. The WHO Ordinal Scale for Clinical Improvement (0-10 points) was used to classify the clinical course. Serum samples were collected at admission, and on days 3 and 7 of hospitalization. KL-6 was measured by using automated chemiluminescence immunoassay. A total of 68 patients developed a severe SARS-CoV-2 pneumonia, 135 of them required oxygen, and 15 died during hospitalization. The patients requiring non-invasive ventilation, invasive ventilation, or extracorporeal membrane oxygenation had significantly higher serum KL-6 levels at admission. The serum KL-6 levels were tendentially higher in patients who died than in those who survived. Logistic regression identified serum KL-6 at a cut-off of 335 U/mL at admission as a significant predictor of severe SARS-CoV-2 pneumonia outcome. Serum KL-6 seems to be a candidate biomarker for the clinical routine to stratify patients with SARS-CoV-2 pneumonia for the risk of a severe disease outcome or death.
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Affiliation(s)
- Simone Kattner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Sivagurunathan Sutharsan
- Center for Interstitial and Rare Lung Disease, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Andreas Limmer
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Lutz-Bernhard Jehn
- Center for Interstitial and Rare Lung Disease, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Frank Herbstreit
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Christian Taube
- Center for Interstitial and Rare Lung Disease, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Disease, Department of Pulmonary Medicine, University Medicine Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
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Canuti M, Monti MC, Bobbio C, Muscatello A, Muheberimana T, Baldi SL, Blasi F, Canetta C, Costantino G, Nobili A, Peyvandi F, Tettamanti M, Villa S, Aliberti S, Raviglione MC, Gori A, Bandera A. The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic. Front Med (Lausanne) 2023; 10:1260950. [PMID: 37746083 PMCID: PMC10513414 DOI: 10.3389/fmed.2023.1260950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico" in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8-20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30-50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23-2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20-0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease.
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Affiliation(s)
- Marta Canuti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Università degli Studi di Pavia, Pavia, Italy
| | - Chiara Bobbio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Antonio Muscatello
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Sante Leandro Baldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ciro Canetta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Simone Villa
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Mario C. Raviglione
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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Milivojević V, Bogdanović J, Babić I, Todorović N, Ranković I. Metabolic Associated Fatty Liver Disease (MAFLD) and COVID-19 Infection: An Independent Predictor of Poor Disease Outcome? Medicina (Kaunas) 2023; 59:1438. [PMID: 37629728 PMCID: PMC10456234 DOI: 10.3390/medicina59081438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Early reports on COVID-19 infection suggested that the SARS-CoV-2 virus solely attacks respiratory tract cells. As the pandemic spread, it became clear that the infection is multiorganic. Metabolic associated fatty liver disease (MAFLD) is a chronic liver disease strongly associated with insulin resistance and diabetes. The aim of this study was to assess a possible interplay between MAFLD and COVID-19 infection and its implication in COVID-19 outcome. Materials and Methods: A retrospective observational study, including 130 COVID-19 positive patients was conducted. MAFLD diagnosis was made based on the International Consensus criteria. Patients were divided into two groups, group A (MAFLD) and group B (nonMAFLD). Anthropometric and laboratory analysis were obtained. COVID-19 severity was assessed using the NEWS2 score. Disease outcome was threefold and regarded as discharged, patients who required mechanical ventilation (MV), and deceased patients. Results: MAFLD prevalence was 42%, 67% of patients were discharged, and 19% needed MV. Mortality rate was 14%. MAFLD patients were significantly younger (p < 0.001), and had higher body mass index (p < 0.05), respiratory rate (p < 0.05) and systolic blood pressure (p < 0.05) than nonMAFLD patients. Regarding metabolic syndrome and inflammatory markers: group A had significantly higher glycemia at admission (p = 0.008), lower HDL-c (p < 0.01), higher triglycerides (p < 0.01), CRP (p < 0.001), IL-6 (p < 0.05) and ferritin (p < 0.05) than group B. MAFLD was associated with more prevalent type 2 diabetes (p = 0.035) and hypertension (p < 0.05). MAFLD patients had a more severe disease course (NEWS2 score, 6.5 ± 0.5 vs. 3 ± 1.0, p < 0.05). MAFLD presence was associated with lower patient discharge (p < 0.01) and increased need for MV (p = 0.024). Multiple regression analysis showed that BMI (p = 0.045), IL-6 (p = 0.03), and MAFLD (p < 0.05) are significant independent risk factors for a poor COVID-19 outcome. Conclusions: The prevalence of MAFLD is relatively high. MAFLD patients had a more severe COVID-19 clinical course and worse disease outcome. Our results imply that early patient stratification and risk assessment are mandatory in order to avoid poor outcomes.
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Affiliation(s)
- Vladimir Milivojević
- Clinic for Gastroenterology and Hepatology University Clinical Centre of Serbia, Dr Koste Todorovica 2, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Jelena Bogdanović
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
- Clinic for Endocrinology, Diabetes and Metabolic Diseases University Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Ivana Babić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases University Clinical Centre of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Nevena Todorović
- Clinic for Infectious and Tropical Diseases University Clinical Centre of Serbia, Bulevar Oslobođenja 16, 11000 Belgrade, Serbia
| | - Ivan Ranković
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, UK;
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Alqatari S, Nemer A, Hasan M, Bukhari R, Al Argan R, Al Khafaji D, Alwaheed A, Alzaki A, Al-wazza M, Al Warthan S, Al Saeed A, Albeladi F, Almeer H, AlSulaiman R, Abu Quren A. COVID-19 in patients with rheumatological diseases in the Eastern Province of Saudi Arabia. J Med Life 2023; 16:873-882. [PMID: 37675163 PMCID: PMC10478665 DOI: 10.25122/jml-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/07/2023] [Indexed: 09/08/2023] Open
Abstract
The severity of the 2019 coronavirus disease (COVID-19) and its effects remain unpredictable. Certain factors, such as obesity, hypertension, and type 2 diabetes mellitus, may increase the severity of the disease. Rheumatology experts suggest that patients with active autoimmune conditions and controlled autoimmune diseases on immunosuppressive therapy may be at higher risk of developing severe COVID-19. In this retrospective observational study, we aimed to examine the patterns of COVID-19 in patients with underlying rheumatological diseases and their association with disease severity and hospital outcomes. A total of 34 patients with underlying rheumatological diseases who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by polymerase chain reaction (PCR) were included between March 2020 and April 2021 at King Fahd Hospital of the University. The study population consisted of 76.47% female and 23.53% male patients, with a mean age ranging from 20 to 40 years. Female gender (p=0.0001) and younger age (p=0.004) were associated with milder disease. The most frequent rheumatological disease was systemic lupus erythematosus (SLE) (38.24%), which was associated with a milder infection (p=0.045). Patients treated with mycophenolate mofetil (MMF) had a milder disease course (p=0.0037). Hypertension was significantly associated with severe COVID-19 disease (p=0.037). There was no significant relationship between SLE and the need for ICU admission. Patients on hydroxychloroquine and MMF tended to develop milder disease, and there was no association between the severity of the infection and the treatment with steroids.
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Affiliation(s)
- Safi Alqatari
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ameera Nemer
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Manal Hasan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Raed Bukhari
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Reem Al Argan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Dania Al Khafaji
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abrar Alwaheed
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Alaa Alzaki
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Marwan Al-wazza
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Sara Al Warthan
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abir Al Saeed
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Feda Albeladi
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hashim Almeer
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Reem AlSulaiman
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed Abu Quren
- Department of Internal Medicine, College of Medicine, King Fahd Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
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Cañedo-Solares I, Correa D, Luna-Pastén H, Ortiz-Alegría LB, Gómez-Chávez F, Xicoténcatl-García L, García LD, Canfield-Rivera CE. Maternal anti-Toxoplasma gondii antibodies IgG2, IgG3 and IgG1 are markers of vertical transmission and clinical evolution of toxoplasmosis in the offspring. Acta Trop 2023; 243:106943. [PMID: 37172708 DOI: 10.1016/j.actatropica.2023.106943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Toxoplasma gondii can be transmitted vertically during pregnancy and may cause neurological, ocular, and even systemic damage to the offspring. Congenital toxoplasmosis (CT) can be diagnosed during gestation and/or after birth in the postnatal period. The timely diagnosis is highly relevant for efficient clinical management. The most common laboratory methods for diagnosing CT are based on Toxoplasma-specific humoral immune responses. However, these methods are of low sensitivity or specificity. In a previous study with a small number of cases, the comparison of anti-T. gondii IgG subclasses between mothers and their offspring showed promising results for CT diagnosis and prognosis. Thus, in this work, we analyzed specific IgG subclasses and IgA in 40 T. gondii-infected mothers and their children, of which 27 were congenitally infected and 13 uninfected. A higher frequency of anti-Toxoplasma IgG2, IgG3, IgG4, and IgA antibodies was observed in mothers and congenitally infected offspring. Of these, IgG2 or IgG3 were statistically the most conspicuous. In the CT group, maternal IgG3 antibodies were significantly associated with severe disease of the infants and IgG1 and IgG3 with disseminated disease. The results support that maternal anti-T. gondii IgG3, IgG2 and IgG1 are markers of congenital transmission and severity/spread of disease in the offspring.
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Affiliation(s)
- Irma Cañedo-Solares
- Laboratorio de Inmunología Experimental, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, México.
| | - Dolores Correa
- Dirección de Investigación / Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac, México.
| | - Hector Luna-Pastén
- Laboratorio de Inmunología Experimental, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Luz Belinda Ortiz-Alegría
- Laboratorio de Inmunología Experimental, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Fernando Gómez-Chávez
- Laboratorio de Inmunología Experimental, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, México; Laboratorio de Enfermedades Osteoarticulares e Inmunológicas, Sección de Estudios de Posgrado e Investigación, ENMyH - IPN, México
| | - Lizbeth Xicoténcatl-García
- Laboratorio de Inmunología Experimental, Subdirección de Medicina Experimental, Instituto Nacional de Pediatría, Secretaría de Salud, México
| | - Luisa Díaz- García
- Departamento de Metodología de la Investigación, Instituto Nacional de Pediatría, Secretaría de Salud, México
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9
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Byrne AB, Bonnin FA, Bruno A, Bono MM, Contrini MM, López EL, Quipildor MO, Talarico LB. Epidemiological and clinical features of the 2016-2018 Zika virus outbreak in northern Argentina. Trans R Soc Trop Med Hyg 2023:7110794. [PMID: 37026534 DOI: 10.1093/trstmh/trad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND During the American epidemic, Zika virus (ZIKV) expanded rapidly through dengue virus (DENV)-endemic regions. We analyzed the presentation of ZIKV infection in patients from the City of Orán, Argentina, and compared some of its features with dengue presentation in the same region. METHODS A retrospective study was conducted at San Vicente de Paul Hospital during 2016-2018. Clinical and demographic characteristics, pre-existing immunity to DENV, viral load and type I interferon (IFN) responses were studied in 63 patients with ZIKV infection. RESULTS Clinical manifestations of ZIKV infection were generally mild compared with dengue, although rash (p<0.001) and itching (p<0.001) were significantly more prevalent in ZIKV patients. ZIKV patients aged <15 y manifested relatively mild disease compared with older ZIKV patients, showing a decreased prevalence of headache (p=0.008), retro-orbital pain (p=0.001) and arthralgia (p=0.001). Increased Zika incidence was observed in female patients (60.3%). Serum viral load was low to undetectable in ZIKV patients and was not associated with serum anti-DENV IgG titers. Interferon-α and IFN-β serum levels did not correlate with serum viral load in ZIKV patients. CONCLUSIONS Clinical presentation of ZIKV and DENV infections is largely overlapping, presenting a challenge for diagnosis and risk assessment for uniquely at-risk populations.
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Affiliation(s)
- Alana B Byrne
- Labora torio de Investigaciones Infectológicas y Biología Molecular, Infectología, Departamento de Medicina, Hospital de Niños Dr Ricardo Gutiérrez, Gallo 1330, Buenos Aires 1425, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Buenos Aires 1425, Argentina
| | - Florencia A Bonnin
- Labora torio de Investigaciones Infectológicas y Biología Molecular, Infectología, Departamento de Medicina, Hospital de Niños Dr Ricardo Gutiérrez, Gallo 1330, Buenos Aires 1425, Argentina
| | - Agostina Bruno
- Hospital San Vicente de Paul, Gral. Pizarro S/N, Orán 4530, Salta, Argentina
| | - María Manuela Bono
- Hospital San Vicente de Paul, Gral. Pizarro S/N, Orán 4530, Salta, Argentina
| | - María Marta Contrini
- Labora torio de Investigaciones Infectológicas y Biología Molecular, Infectología, Departamento de Medicina, Hospital de Niños Dr Ricardo Gutiérrez, Gallo 1330, Buenos Aires 1425, Argentina
| | - Eduardo L López
- Labora torio de Investigaciones Infectológicas y Biología Molecular, Infectología, Departamento de Medicina, Hospital de Niños Dr Ricardo Gutiérrez, Gallo 1330, Buenos Aires 1425, Argentina
| | - Marcelo O Quipildor
- Hospital San Vicente de Paul, Gral. Pizarro S/N, Orán 4530, Salta, Argentina
| | - Laura B Talarico
- Labora torio de Investigaciones Infectológicas y Biología Molecular, Infectología, Departamento de Medicina, Hospital de Niños Dr Ricardo Gutiérrez, Gallo 1330, Buenos Aires 1425, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz 2290, Buenos Aires 1425, Argentina
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10
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Zamani B, Momen-Heravi M, Erami M, Motedayyen H, ArefNezhad R. Impacts of IL-27 and IL-32 in the pathogenesis and outcome of COVID-19 associated mucormycosis. J Immunoassay Immunochem 2023; 44:242-255. [PMID: 36602425 DOI: 10.1080/15321819.2022.2164506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Changes in the immune system participate in the pathogenesis and development of infectious diseases. Previous studies have indicated immune dysregulation in patients suffering from COVID-19 and mucormycosis. Therefore, this study investigated whether interleukin-27 (IL-27) and interleukin-32 (IL-32) levels may participate in the development and outcome of COVID-19 associated mucormycosis (CAM). The blood samples were obtained from 79 patients suffering from COVID-19 and mucormycosis and 25 healthy subjects. The serum samples were isolated from the whole blood and frequencies of some immune cells were measured by a cell counter. The levels of IL-27 and IL-32 were assessed by enzyme-linked immunosorbent assay. IL-27 and IL-32 levels were significantly lower in patients with COVID-19 and mucormycosis than healthy subjects (P < .05), although there was no significant difference in IL-27 between patients with COVID-19 and CAM. IL-27 level was significantly higher in severe COVID-19 survivors than dead cases (P < .01). Patients with CAM had significant increases in NLR compared to COVID-19 patients and healthy individuals (P < .0001-0.01). NLR was significantly associated with COVID-19 outcome (P < .05). Severe COVID-19 survivors had a significant reduction in NLR compared to non-survivors (P < .05). Changes in IL-27 and IL-32 levels may contribute to the pathogenesis of CAM. IL-27 may relate to the pathogenesis and outcomes of mucormycosis in COVID-19 patients.
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Affiliation(s)
- Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Diseases, School of Medicine, Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahzad Erami
- Kashan Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Motedayyen
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
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11
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Yu H, Li L, Huffman A, Beverley J, Hur J, Merrell E, Huang HH, Wang Y, Liu Y, Ong E, Cheng L, Zeng T, Zhang J, Li P, Liu Z, Wang Z, Zhang X, Ye X, Handelman SK, Sexton J, Eaton K, Higgins G, Omenn GS, Athey B, Smith B, Chen L, He Y. A new framework for host-pathogen interaction research. Front Immunol 2022; 13:1066733. [PMID: 36591248 PMCID: PMC9797517 DOI: 10.3389/fimmu.2022.1066733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Abstract
COVID-19 often manifests with different outcomes in different patients, highlighting the complexity of the host-pathogen interactions involved in manifestations of the disease at the molecular and cellular levels. In this paper, we propose a set of postulates and a framework for systematically understanding complex molecular host-pathogen interaction networks. Specifically, we first propose four host-pathogen interaction (HPI) postulates as the basis for understanding molecular and cellular host-pathogen interactions and their relations to disease outcomes. These four postulates cover the evolutionary dispositions involved in HPIs, the dynamic nature of HPI outcomes, roles that HPI components may occupy leading to such outcomes, and HPI checkpoints that are critical for specific disease outcomes. Based on these postulates, an HPI Postulate and Ontology (HPIPO) framework is proposed to apply interoperable ontologies to systematically model and represent various granular details and knowledge within the scope of the HPI postulates, in a way that will support AI-ready data standardization, sharing, integration, and analysis. As a demonstration, the HPI postulates and the HPIPO framework were applied to study COVID-19 with the Coronavirus Infectious Disease Ontology (CIDO), leading to a novel approach to rational design of drug/vaccine cocktails aimed at interrupting processes occurring at critical host-coronavirus interaction checkpoints. Furthermore, the host-coronavirus protein-protein interactions (PPIs) relevant to COVID-19 were predicted and evaluated based on prior knowledge of curated PPIs and domain-domain interactions, and how such studies can be further explored with the HPI postulates and the HPIPO framework is discussed.
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Affiliation(s)
- Hong Yu
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital and National Health Commission (NHC) Key Laboratory of Immunological Diseases, People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
- Department of Basic Medicine, Guizhou University Medical College, Guiyang, Guizhou, China
| | - Li Li
- Department of Genetics, Harvard Medical School, Boston, MA, United States
| | - Anthony Huffman
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - John Beverley
- Department of Philosophy, University at Buffalo, Buffalo, NY, United States
- Asymmetric Operations Sector, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, United States
| | - Junguk Hur
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, United States
| | - Eric Merrell
- Department of Philosophy, University at Buffalo, Buffalo, NY, United States
| | - Hsin-hui Huang
- University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yang Wang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital and National Health Commission (NHC) Key Laboratory of Immunological Diseases, People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
- Department of Basic Medicine, Guizhou University Medical College, Guiyang, Guizhou, China
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Yingtong Liu
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Edison Ong
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Liang Cheng
- Department of Bioinformatics, Harbin Medical University, Harbin, Helongjian, China
| | - Tao Zeng
- Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China
| | - Jingsong Zhang
- Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China
| | - Pengpai Li
- Center of Intelligent Medicine, School of Control Science and Engineering, Shandong University, Jinan, Shandong, China
| | - Zhiping Liu
- Center of Intelligent Medicine, School of Control Science and Engineering, Shandong University, Jinan, Shandong, China
| | - Zhigang Wang
- Department of Biomedical Engineering, Institute of Basic Medical Sciences and School of Basic Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangyan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital and National Health Commission (NHC) Key Laboratory of Immunological Diseases, People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
- Department of Basic Medicine, Guizhou University Medical College, Guiyang, Guizhou, China
| | - Xianwei Ye
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People’s Hospital and National Health Commission (NHC) Key Laboratory of Immunological Diseases, People’s Hospital of Guizhou Province, Guiyang, Guizhou, China
- Department of Basic Medicine, Guizhou University Medical College, Guiyang, Guizhou, China
| | | | - Jonathan Sexton
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kathryn Eaton
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Gerry Higgins
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Gilbert S. Omenn
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brian Athey
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Barry Smith
- Department of Philosophy, University at Buffalo, Buffalo, NY, United States
| | - Luonan Chen
- Key Laboratory of Systems Biology, Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai, China
| | - Yongqun He
- University of Michigan Medical School, Ann Arbor, MI, United States
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12
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Zamani B, Najafizadeh M, Motedayyen H, Arefnezhad R. Predicting roles of IL-27 and IL-32 in determining the severity and outcome of COVID-19. Int J Immunopathol Pharmacol 2022; 36:3946320221145827. [PMID: 36476070 PMCID: PMC9742516 DOI: 10.1177/03946320221145827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Immune changes play fundamental roles in the pathogenesis and severity of coronavirus disease 2019 (COVID-19). Previous studies have revealed alterations in immune responses of patients with non-severe and severe COVID-19. Therefore, this study investigated whether interleukin-27 (IL-27) and interleukin-32 (IL-32) levels may be considered as predicting factors for determining the severity and outcome of COVID-19. METHODS The blood samples were collected from 50 non-severe and severe patients infected with COVID-19 and 25 healthy subjects. The serum samples were isolated from the whole blood. The levels of IL-27 and IL-32 were measured by enzyme-linked immunosorbent assay and percentages of some immune cells were studied by cell counter. RESULTS The levels of IL-27 and IL-32 were significantly higher in COVID-19 patients than healthy subjects (p < 0.0001-0.01). IL-27 was significantly reduced in severe COVID-19 patients who needed to undergo ICU therapy (p < 0.05). Disease severity was significantly associated with IL-27 level in patients with COVID-19 (p < 0.05), unlike IL-32 level. There was a significant association between IL-27 and IL-32 in participants (p < 0.0001, odds ratio (OR) = 0.9873; 95% confidence interval (CI) = 0.9998 to 1.000; p < 0.05, OR = 0.4462; 95% CI = 0.08,579 to 0.7802; p < 0.01, OR = 0.6640, 95% CI = 0.3007-0.8590). IL-27 level was significantly higher in the recovered subjects than dead cases (p < 0.0001). IL-27 and IL-32 levels in patients who had fever were significantly higher than those who did not have (p < 0.01-0.05), unlike patients who suffered from cough (p < 0.001-0.01). The IL-27 level in patients with non-severe COVID-19 was directly correlated with CRP value (p < 0.05, OR = 0.5,722,357, 95% CI = 0.06,807,176-0.8,435,928). IL-27 and IL-32 levels in non-severe patients were positively associated with NLR (p < 0.01, OR = 0.7292; 95% CI = 0.2809 to 0.9163; p < 0.01, OR = 0.6537, 95% CI = 0.1425-0.8896). Patients with severe COVID-19 had a significant increase in NLR (p < 0.0001-0.05). NLR was significantly correlated with the disease severity (p < 0.0001-0.05). Survivors had a significant reduction in NLR compared with those who succumbed to COVID-19 (p < 0.05). CONCLUSION Change in IL-27 level along with the frequencies of some immune cells may serve as a predictor of the severity and outcome of COVID-19.
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Affiliation(s)
- Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Maedeh Najafizadeh
- Infectious Disease Research Center, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Motedayyen
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran,Hossein Motedayyen, Autoimmune Diseases Research Center, Shahid Beheshti Hospital, Kashan University of Medical Sciences, 5th Kilometer of Ravand Road, Kashan, Iran. ; Reza ArefNezhad, Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. reza.aref1374@gmail
| | - Reza Arefnezhad
- Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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13
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Yarwood A, Shoop-Worrall S, López-Isac E, Smith SL, Morris AP, Bowes JD, Tordoff M, Hyrich KL, Thomson W, Eyre S. No evidence that genetic predictors of susceptibility predict changes in core outcomes in JIA. Rheumatology (Oxford) 2022; 61:4136-4144. [PMID: 35015833 PMCID: PMC9536790 DOI: 10.1093/rheumatology/keab942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/15/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The clinical progression of JIA is unpredictable. Knowing who will develop severe disease could facilitate rapid intensification of therapies. We use genetic variants conferring susceptibility to JIA to predict disease outcome measures. METHODS A total of 713 JIA patients with genotype data and core outcome variables (COVs) at diagnosis (baseline) and 1 year follow-up were identified from the Childhood Arthritis Prospective Study (CAPS). A weighted genetic risk score (GRS) was generated, including all single nucleotide polymorphisms (SNPs) previously associated with JIA susceptibility (P-value < 5×10-08). We used multivariable linear regression to test the GRS for association with COVS (limited joint count, active joint count, physician global assessment, parent/patient general evaluation, childhood HAQ and ESR) at baseline and change in COVS from baseline to 1 year, adjusting for baseline COV and International League of Associations of Rheumatology (ILAR) category. The GRS was split into quintiles to identify high (quintile 5) and low (quintile 1) risk groups. RESULTS Patients in the high-risk group for the GRS had a younger age at presentation (median low risk 7.79, median high risk 3.51). No association was observed between the GRS and any outcome measures at 1 year follow-up or baseline. CONCLUSION For the first time we have used all known JIA genetic susceptibility loci (P=<5×10-08) in a GRS to predict changes in disease outcome measured over time. Genetic susceptibility variants are poor predictors of changes in core outcome measures, it is likely that genetic factors predicting disease outcome are independent to those predicting susceptibility. The next step will be to conduct a genome-wide association analysis of JIA outcome.
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Affiliation(s)
- Annie Yarwood
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust
| | - Stephanie Shoop-Worrall
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre
- Centre for Health Informatics, The University of Manchester, Manchester, UK
| | - Elena López-Isac
- Department of Biochemistry and Molecular Biology II, The University of Granada, Andalucía, Spain
| | - Samantha Louise Smith
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
| | - Andrew P Morris
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust
| | | | - John David Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust
| | - Melissa Tordoff
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
| | - Kimme L Hyrich
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre
| | - Wendy Thomson
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust
| | - Stephen Eyre
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester
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14
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Kabirpanthi V, Gupta V, Singh A. Clinical features and haematological parameters associated with COVID-19 severity among hospitalized patients: A retrospective observational study from Tribal Central India. J Family Med Prim Care 2022; 11:6042-6048. [PMID: 36618258 PMCID: PMC9810897 DOI: 10.4103/jfmpc.jfmpc_138_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background Reports describing demographics, clinical characteristics, hospital course, morbidity, and mortality in patients in the Indian setting have been published, but they are based on limited numbers of cases. The present study among the patients with known outcomes enabled us to better understand the disease process and progression of COVID-19 cases and to correlate the factors affecting the outcome. Methods This was a record-based, retrospective observational study of patients admitted to COVID-19 Hospital. We have retrieved medical records for all the hospitalized patients with a laboratory confirmed COVID-19 diagnosis with a known outcome (discharged or died) between April 1, 2020 and February 28, 2021. The extracted data included basic demographics, signs and symptoms, duration of hospitalization, and laboratory parameters. Categorical variables were analysed using either the chisquare test or Fisher's exact test. The level of significance was set at P < 0.05. Results The mean age of severe and moderate patients was 38.71 years, compared to 34.95 years for mild patients. No gender difference was observed for the severe/moderate, and mild cases. The mortality rate among severe/moderate cases was 11.6%, whereas it was 3.9% in mild patients. Laboratory parameters which were significantly (p < 0.05) raised among the dead compared to discharged patients included CT score, D-dimer, CRP, ALT, AST, and alkaline phosphatase. Conclusion Clinical and laboratory characteristics reflect the pathophysiology of disease and thus help clinicians recognise the severity of medical illness. They also facilitate the creation of management protocols for clinical care that results in improvement in patient related outcomes.
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Affiliation(s)
- Vikrant Kabirpanthi
- Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
| | - Vikas Gupta
- Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India,Address for correspondence: Dr. Vikas Gupta, Department of Community Medicine Government Medical College, Shahdol, Madhya Pradesh, India. E-mail:
| | - Ajit Singh
- Department of Pathology, Kalpana Chawla Government Medical College, Karnal, Haryana, India
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15
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Devi P, Maurya R, Mehta P, Shamim U, Yadav A, Chattopadhyay P, Kanakan A, Khare K, Vasudevan JS, Sahni S, Mishra P, Tyagi A, Jha S, Budhiraja S, Tarai B, Pandey R. Increased Abundance of Achromobacter xylosoxidans and Bacillus cereus in Upper Airway Transcriptionally Active Microbiome of COVID-19 Mortality Patients Indicates Role of Co-Infections in Disease Severity and Outcome. Microbiol Spectr 2022; 10:e0231121. [PMID: 35579429 PMCID: PMC9241827 DOI: 10.1128/spectrum.02311-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/17/2022] [Indexed: 12/13/2022] Open
Abstract
The modulators of severe COVID-19 have emerged as the most intriguing features of SARS-CoV-2 pathogenesis. This is especially true as we are encountering variants of concern (VOC) with increased transmissibility and vaccination breakthroughs. Microbial co-infections are being investigated as one of the crucial factors for exacerbation of disease severity and complications of COVID-19. A key question remains whether early transcriptionally active microbial signature/s in COVID-19 patients can provide a window for future disease severity susceptibility and outcome? Using complementary metagenomics sequencing approaches, respiratory virus oligo panel (RVOP) and Holo-seq, our study highlights the possible functional role of nasopharyngeal early resident transcriptionally active microbes in modulating disease severity, within recovered patients with sub-phenotypes (mild, moderate, severe) and mortality. The integrative analysis combines patients' clinical parameters, SARS-CoV-2 phylogenetic analysis, microbial differential composition, and their functional role. The clinical sub-phenotypes analysis led to the identification of transcriptionally active bacterial species associated with disease severity. We found significant transcript abundance of Achromobacter xylosoxidans and Bacillus cereus in the mortality, Leptotrichia buccalis in the severe, Veillonella parvula in the moderate, and Actinomyces meyeri and Halomonas sp. in the mild COVID-19 patients. Additionally, the metabolic pathways, distinguishing the microbial functional signatures between the clinical sub-phenotypes, were also identified. We report a plausible mechanism wherein the increased transcriptionally active bacterial isolates might contribute to enhanced inflammatory response and co-infections that could modulate the disease severity in these groups. Current study provides an opportunity for potentially using these bacterial species for screening and identifying COVID-19 patient sub-groups with severe disease outcome and priority medical care. IMPORTANCE COVID-19 is invariably a disease of diverse clinical manifestation, with multiple facets involved in modulating the progression and outcome. In this regard, we investigated the role of transcriptionally active microbial co-infections as possible modulators of disease pathology in hospital admitted SARS-CoV-2 infected patients. Specifically, can there be early nasopharyngeal microbial signatures indicative of prospective disease severity? Based on disease severity symptoms, the patients were segregated into clinical sub-phenotypes: mild, moderate, severe (recovered), and mortality. We identified significant presence of transcriptionally active isolates, Achromobacter xylosoxidans and Bacillus cereus in the mortality patients. Importantly, the bacterial species might contribute toward enhancing the inflammatory responses as well as reported to be resistant to common antibiotic therapy, which together hold potential to alter the disease severity and outcome.
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Affiliation(s)
- Priti Devi
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Ranjeet Maurya
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Priyanka Mehta
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Uzma Shamim
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Aanchal Yadav
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Partha Chattopadhyay
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Akshay Kanakan
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Kriti Khare
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Janani Srinivasa Vasudevan
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Shweta Sahni
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Pallavi Mishra
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
| | - Akansha Tyagi
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Delhi, India
| | - Sujeet Jha
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Delhi, India
| | - Sandeep Budhiraja
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Delhi, India
| | - Bansidhar Tarai
- Max Super Speciality Hospital (A Unit of Devki Devi Foundation), Delhi, India
| | - Rajesh Pandey
- INtegrative GENomics of HOst-PathogEn (INGEN-HOPE) Laboratory, CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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Adas MA, Norton S, Balachandran S, Alveyn E, Russell MD, Esterine T, Amlani-Hatcher P, Oyebanjo S, Lempp H, Ledingham J, Kumar K, Galloway JB, Dubey S. Worse outcomes linked to ethnicity for early inflammatory arthritis in England and Wales: a national cohort study. Rheumatology (Oxford) 2022; 62:169-180. [PMID: 35536178 PMCID: PMC9788810 DOI: 10.1093/rheumatology/keac266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess variability in care quality and treatment outcomes across ethnicities in early inflammatory arthritis (EIA). METHODS We conducted an observational cohort study in England and Wales from May 2018 to March 2020, including patients with a suspected/confirmed EIA diagnosis. Care quality was assessed against six metrics defined by national guidelines. Clinical outcomes were measured using DAS28. Outcomes between ethnic groups ('White', 'Black', 'Asian', 'Mixed', 'Other') were compared, and adjusted for confounders. RESULTS A total of 35 807 eligible patients were analysed. Of those, 30 643 (85.6%) were White and 5164 (14.6%) were from ethnic minorities: 1035 (2.8%) Black; 2617 (7.3%) Asian; 238 (0.6%) Mixed; 1274 (3.5%) Other. In total, 12 955 patients had confirmed EIA, of whom 11 315 were White and 1640 were from ethnic minorities: 314 (2.4%) Black; 927 (7.1%) Asian; 70 (0.5%) Mixed; 329 (2.5%) Other. A total of 14 803 patients were assessed by rheumatology within three weeks, and 5642 started treatment within six weeks of referral. There were no significant differences by ethnicity. Ethnic minority patients had lower odds of disease remission at three months [adjusted odds ratio 0.79 (95% CI: 0.65, 0.96)] relative to White patients. Ethnic minorities were significantly less likely to receive initial treatment withMTX[0.68 (0.52, 0.90)] or with glucocorticoids [0.63 (0.49, 0.80)]. CONCLUSION We demonstrate that some ethnic minorities are less likely to achieve disease remission in three months following EIA diagnosis. This is not explained by delays in referral or time to treatment. Our data highlight the need for investigation into the possible drivers of these inequitable outcomes and reappraisal of EIA management pathways.
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Affiliation(s)
| | | | | | - Edward Alveyn
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | - Mark D Russell
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | | | | | | | - Heidi Lempp
- Centre for Rheumatic Disease, Department of Inflammatory Biology
| | - Joanna Ledingham
- Rheumatology Department, Portsmouth Hospitals University NHS Trust, Portsmouth
| | - Kanta Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham
| | - James B Galloway
- Correspondence to: James Galloway, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK. E-mail:
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Öztürk FÜ, Bülbül SF, Alpcan A. Assessment of parents´ knowledge regarding phenylketonuria and its affecting factors: a cross-sectional study. Pan Afr Med J 2022; 41:308. [PMID: 35855041 PMCID: PMC9250662 DOI: 10.11604/pamj.2022.41.308.25936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 08/14/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction the management of phenylketonuria (PKU) is complex. Practical skills and knowledge of individuals taking care of PKU patients are important for treatment compliance. This study investigated parents´ knowledge about PKU and its affecting factors. The study group consisted of 62 parents of PKU patients. Methods data were collected using a ready-made questionnaire on sociodemographic characteristics, PKU and dietary treatment. Total knowledge score (KS) was calculated by giving 5 points for each correct answer. Results the study included 34 mothers and 28 fathers; 90.3% of patients were diagnosed during the newborn screening program, 6.5% between ages 1 and 2, and 3.2% at age 6 or after. Among all, 38.7% presented to their follow-up appointments with their mothers, 61.3% with both their parents and none with their father alone. Mothers answered all questions more accurately than fathers. Mothers´ and fathers´ mean KSs were 73.97 ± 12.72 and 53.04 ± 22.25, respectively. The highest KS was obtained among parents whose children were 13 years of age or older. Conclusion the presence of another family member, parents´ education level, working status and professional qualifications, previous training on PKU and family´s economic status were the affecting factors. Creating a PKU dietary plan requires knowledge and diligence. Patients and their parents should be periodically informed about the disease and dietary treatment in order to increase their level of knowledge.
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Affiliation(s)
- Fatma Üneşi Öztürk
- Kirikkale University School of Medicine, Department of Pediatric Metabolic Diseases and Nutrition, Kirikkale, Turkey
| | - Selda Fatma Bülbül
- Kirikkale University School of Medicine, Department of Pediatric Metabolic Diseases and Nutrition, Kirikkale, Turkey
| | - Ayşegül Alpcan
- Kirikkale University School of Medicine, Department of Pediatric Metabolic Diseases and Nutrition, Kirikkale, Turkey,Corresponding author: Ayşegül Alpcan, Kirikkale University School of Medicine, Department of Pediatric Metabolic Diseases and Nutrition, Kirikkale, Turkey.
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Ismail N, Hassan N, Abd Hamid MHN, Yusoff UN, Khamal NR, Omar MA, Wong XC, Pathmanathan MD, Mohd Zin S, Muhammad Zin F, Nik Mohamed MH, Mohd Nor N. ASSOCIATION OF SMOKING AND SEVERITY OF COVID-19 INFECTION AMONG 5,889 PATIENTS IN MALAYSIA: A MULTI-CENTER OBSERVATIONAL STUDY. Int J Infect Dis 2022; 116:189-196. [PMID: 35021062 PMCID: PMC8743378 DOI: 10.1016/j.ijid.2022.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to investigate the association between smoking and the severity of COVID-19 infection during the initial wave of this pandemic in Malaysia. Methods This is a multi-center observational study using secondary hospital data collected retrospectively from February 1, 2020, until May 30, 2020. Clinical records of all real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases with smoking status, co-morbidities, clinical features, and disease management were retrieved. Severity was assessed by the presence of complications and outcomes of COVID-19 infection. Logistic regression was used to determine the association between COVID-19 disease severity and smoking status. Results A total of 5,889 COVID-19 cases were included in the analysis. Ever smokers had a higher risk of having COVID-19 complications, such as acute respiratory distress syndrome (odds ratio [OR] 1.69; 95% confidence interval [CI] 1.09-2.55), renal injury (OR 1.55; 95% CI 1.10-2.14), and acute liver injury (OR 1.33; 95% CI 1.01-1.74), compared with never smokers. However, in terms of disease outcomes, there were no differences between the two groups. Conclusion Although no significant association was found in terms of disease outcomes, smoking is associated with a higher risk of having complications owing to COVID-19 infection.
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Affiliation(s)
| | | | | | | | | | | | - Xin Ci Wong
- Digital Health Research and Innovation Unit, Institute for Clinical Research, Malaysia
| | | | | | | | - Mohamad Haniki Nik Mohamed
- Kulliyyah of Pharmacy, International Islamic University of Malaysia (Chairman of Technical Working Group World Health Organization Framework Convention on Tobacco Control Malaysia)
| | - Norashidah Mohd Nor
- Faculty of Economy, University Putra Malaysia (Vice Chairman of Technical Working Group World Health Organization Framework Convention on Tobacco Control Malaysia)
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Al Argan R, Alkhafaji D, Al Elq A, Albaker W, Alqatari S, Alzaki A, Alwaheed A, Al Said A, Bukhari H, Al Warthan S, Zeeshan M, AlRubaish F, AlElq Z, Alsahlawi A, Alalwan M, AlHwiesh A, Alabdrabalnabi FI. The Impact of Diabetes Mellitus and Hyperglycemia on the Severity and Outcome of Patients with COVID-19 Disease: A Single-Center Experience. Int J Gen Med 2021; 14:9445-9457. [PMID: 34908871 PMCID: PMC8664338 DOI: 10.2147/ijgm.s338800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Diabetes mellitus (DM) has been reported to be associated with a worse outcome of COVID-19 infection. The evidence is scarce in the Middle East and Saudi Arabia. We aimed to evaluate the impact of diabetes mellitus and hyperglycemia in non-diabetic individuals on the severity and outcome of COVID-19 infection. Methods This is a retrospective observational study, which included patients with confirmed COVID-19 infection [RT-PCR positive for SARS-CoV2] who were admitted to King Fahd Hospital of the University-Khobar-Eastern Province-Saudi Arabia from March to September 2020. Baseline demographic data, laboratory investigations, and markers of the severity of COVID-19 were analyzed. The collected data were categorized according to the Saudi Arabian Ministry of Health COVID-19 infection severity criteria. Patients were divided into three groups as follows: patients in Group 1 had pre-existing DM, patients in Group 2 did not have DM but were documented to have hyperglycemia at presentation, and patients in Group 3 were neither diabetics nor hyperglycemics at presentation and served as the control group. The severity and outcome of the control group were compared with the other two groups. The effect of risk factors on the severity and outcome of COVID-19 infection was studied in the DM group. Results A total of 414 patients were included (70.5% males and 29.5% females). The mean age (SD) of patients was 52.3 (±15.5) years. Compared to the control group, pre-existing DM was found to be significantly associated with severe (OR 3.61), critical disease (OR 4.32), intensive care unit (ICU) admission (OR 2.0), and death (OR 2.0) from COVID-19 infection. Hyperglycemia without known DM was also found to be associated with critical COVID-19 pneumonia (P 0.001), and had longer duration of hospitalization (P 0.014), higher ICU admission, mechanical ventilation, and death from COVID-19 infection (P < 0.0001). Conclusion Diabetes mellitus and hyperglycemia at presentation, even in the absence of pre-existing DM, are independent risk factors for disease severity and worse outcome of COVID-19 infection. These patients should be identified and managed accordingly. The COVID-19 vaccination program should also target those populations to improve their outcomes.
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Affiliation(s)
- Reem Al Argan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Dania Alkhafaji
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abdulmohsen Al Elq
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Waleed Albaker
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Safi Alqatari
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Alaa Alzaki
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abrar Alwaheed
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abir Al Said
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Huda Bukhari
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Sara Al Warthan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Mohammad Zeeshan
- Department of Medical Education, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Fatimah AlRubaish
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Zainab AlElq
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Ahmed Alsahlawi
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Mohannad Alalwan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Amani AlHwiesh
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Fatimah I Alabdrabalnabi
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
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Verstockt B, Noor NM, Marigorta UM, Pavlidis P, Deepak P, Ungaro RC. Results of the Seventh Scientific Workshop of ECCO: Precision Medicine in IBD- Disease Outcome and Response to Therapy. J Crohns Colitis 2021; 15:1431-1442. [PMID: 33730756 PMCID: PMC8681673 DOI: 10.1093/ecco-jcc/jjab050] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases [IBD] are a heterogeneous spectrum with two extreme phenotypes, Crohn's disease [CD] and ulcerative colitis [UC], which both represent numerous phenotypical variations. Hence, we should no longer approach all IBD patients similarly, but rather aim to rethink clinical classifications and modify treatment algorithms to usher in a new era of precision medicine in IBD. This scientific ECCO workshop aims to provide a state-of-the-art overview on prognostic and predictive markers, shed light on key questions in biomarker development, propose best practices in IBD biomarker development [including trial design], and discuss the potential for multi-omic data integration to help drive further advances to make precision medicine a reality in IBD.
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Affiliation(s)
- Bram Verstockt
- University Hospitals Leuven Department of Gastroenterology and Hepatology, KU Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders [TARGID], Leuven, Belgium
| | - Nurulamin M Noor
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Urko M Marigorta
- Integrative Genomics Lab, Center for Cooperative Research in Biosciences [CIC bioGUNE], Basque Research and Technology Alliance [BRTA], Derio, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
| | - Polychronis Pavlidis
- Department of Gastroenterology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Parakkal Deepak
- Inflammatory Bowel Diseases Center, Washington University in Saint Louis School of Medicine, St Louis, MO, USA
| | - Ryan C Ungaro
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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De Souza FSH, Hojo-Souza NS, Dos Santos EB, Da Silva CM, Guidoni DL. Predicting the Disease Outcome in COVID-19 Positive Patients Through Machine Learning: A Retrospective Cohort Study With Brazilian Data. Front Artif Intell 2021; 4:579931. [PMID: 34514377 PMCID: PMC8427867 DOI: 10.3389/frai.2021.579931] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/02/2021] [Indexed: 01/08/2023] Open
Abstract
The first officially registered case of COVID-19 in Brazil was on February 26, 2020. Since then, the situation has worsened with more than 672, 000 confirmed cases and at least 36, 000 reported deaths by June 2020. Accurate diagnosis of patients with COVID-19 is extremely important to offer adequate treatment, and avoid overloading the healthcare system. Characteristics of patients such as age, comorbidities and varied clinical symptoms can help in classifying the level of infection severity, predict the disease outcome and the need for hospitalization. Here, we present a study to predict a poor prognosis in positive COVID-19 patients and possible outcomes using machine learning. The study dataset comprises information of 8, 443 patients concerning closed cases due to cure or death. Our experimental results show the disease outcome can be predicted with a Receiver Operating Characteristic AUC of 0.92, Sensitivity of 0.88 and Specificity of 0.82 for the best prediction model. This is a preliminary retrospective study which can be improved with the inclusion of further data. Conclusion: Machine learning techniques fed with demographic and clinical data along with comorbidities of the patients can assist in the prognostic prediction and physician decision-making, allowing a faster response and contributing to the non-overload of healthcare systems.
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Affiliation(s)
| | | | | | | | - Daniel Ludovico Guidoni
- Department of Computer Science, Federal University of São João Del-Rei, São João Del-Rei, Brazil
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22
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Greuter T, Porchet F, Braga-Neto MB, Rossel JB, Biedermann L, Schreiner P, Scharl M, Schoepfer AM, Safroneeva E, Straumann A, Rogler G, Vavricka SR. Impact of obesity on disease activity and disease outcome in inflammatory bowel disease: Results from the Swiss inflammatory bowel disease cohort. United European Gastroenterol J 2021; 8:1196-1207. [PMID: 33276710 DOI: 10.1177/2050640620954556] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the impact of obesity on disease activity and disease outcome in patients with inflammatory bowel disease. PATIENTS AND METHODS The impact of obesity on inflammatory bowel disease disease activity and outcome was retrospectively assessed in 3075 patients enrolled in the prospective nation-wide Swiss inflammatory bowel disease cohort between July 2006 and September 2018. Baseline characteristics, disease activity and disease course in 325 obese inflammatory bowel disease patients (body mass index ≥30 kg/m2) were compared to 1725 normal weight inflammatory bowel disease individuals (body mass index 18.5-24.9). RESULTS Among 3075 patients in the prospective Swiss inflammatory bowel disease cohort, 325 patients (10.6%) were obese, namely, 194 Crohn's disease patients, 131 ulcerative colitis, and inflammatory bowel disease-unclassified patients. Disease activity scores were elevated in obese Crohn's disease (Crohn's Disease Activity Index 33 vs 20, p = 0.001), but not ulcerative colitis patients. Obese Crohn's disease, but not ulcerative colitis patients were less likely to be in remission based on a Crohn's Disease Activity Index less than 100 and a calprotectin less than 100 ug/g. In a multivariate regression model, obesity was negatively associated with disease remission in Crohn's disease (odds ratio 0.610, 95% confidence interval 0.402-0.926, p = 0.020), but not ulcerative colitis. Increased soft stool frequency was observed in both obese Crohn's disease and ulcerative colitis patients. Adjusted Cox regression models revealed increased risk of complicated disease course in obese Crohn's disease patients (hazard ratio 1.197, 95% confidence interval 1.046-1.370, p = 0.009). No association between obesity and disease progression, index treatment failure was seen neither in Crohn's disease nor ulcerative colitis. CONCLUSION Obesity is associated with decreased rates of disease remission and increased risk of complicated disease course in Crohn's disease over a six-year follow-up period. No effects were seen on disease progression and index treatment failure neither in Crohn's disease nor ulcerative colitis.
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Affiliation(s)
- Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Department of Medicine, GZO Regional Health Center, Zurich, Switzerland.,Division of Gastroenterology and Hepatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Frédéric Porchet
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Jean-Benoit Rossel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Alain M Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Center for Gastroenterology and Hepatology, Zurich, Switzerland
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Han H, Peng X, Zheng F, Deng G, Cheng X, Peng L. Association of Gender With Outcomes in Hospitalized Patients With 2019-nCoV Infection in Wuhan. Front Public Health 2021; 9:619482. [PMID: 34211948 PMCID: PMC8239169 DOI: 10.3389/fpubh.2021.619482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/21/2021] [Indexed: 12/04/2022] Open
Abstract
Aim: The aim of this study was to analyze the association of gender with psychological status and clinical outcomes among patients with 2019-nCoV infection to provide new directions for the prevention and control of the pandemic. Methods: One hundred and thirty-eight patients with confirmed 2019-nCoV infection at Wuhan Union Hospital, between February 8 and March 31, 2020, were included in the study analysis. General information and data on clinical characteristics were collected from patients' medical records. Participants' responses to self-report measures of psychological status were also collected. Results: Anxiety levels, depression levels, and recovery rates were significantly higher among women compared to men. Conversely, chronic disease history and smoking rates, dry cough incidence, C-reactive protein levels, and disease severity were significantly higher among men than women (p < 0.05). Conclusion: Female patients experienced more severe psychological issues, due to higher levels of anxiety and stress, than male patients; indicating that more attention should be paid to the psychological care of female patients. In contrast, the general condition of male patients was more severe, particularly among elderly male patients with a history of chronic disease and smoking, suggesting that, to prevent and control 2019-nCoV infection, male patients should be encouraged to quit smoking as soon as possible to reduce the risk of severe pneumonia.
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Affiliation(s)
- Huiwu Han
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.,Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaobei Peng
- Critical Care Medicine Department, Xiangya Hospital at Central South University, Changsha, China
| | - Fan Zheng
- Health Management Department, Xiangya Hospital at Central South University, Changsha, China
| | - Guiyuan Deng
- Cardiovascular Medicine Department, Xiangya Hospital at Central South University, Changsha, China
| | - Xiaocui Cheng
- Ophthalmology Department, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Peng
- Cardiovascular Medicine Department, Xiangya Hospital at Central South University, Changsha, China
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Lu Y, Yan Y, Liu X. Effects of alprostadil combined with tanshinone IIa injection on microcirculation disorder, outcomes, and cardiac function in AMI patients after PCI. Ann Palliat Med 2021; 10:97-103. [PMID: 33545751 DOI: 10.21037/apm-20-2147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Alprostadil can effectively dilate blood vessels, improve cardiac microcirculation, and reduce cardiac load. Tanshinone IIa injection can protect against atherosclerosis and reduce myocardial oxygen consumption. However, the effects of alprostadil combined with tanshinone IIa injection on microcirculation disorder, outcomes, and cardiac function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) are still not fully clear. METHODS A total of 300 AMI patients who underwent PCI in our hospital from January 2013 to June 2018 were randomly selected and divided into group A, B, C by using the random number table method, with 100 patients in each group. The group A was treated with alprostadil, the group B was treated with tanshinone IIa injection, and the group C was treated with alprostadil combined with tanshinone IIa injection. 7 days after treatment, the cardiac functions of all patients were observed by ultrasonic Doppler, as were the microcirculations by myocardial contrast echocardiography (MCE). The major adverse cardiac events (MACEs) in both groups were observed in the 12-month follow-up. RESULTS After treatment, the left ventricular end-diastolic diameter (LVEDD), end-diastolic left ventricular posterior wall thickness (LVPWD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVST), and ratio of maximal early to late diastolic filling velocities (E/A) in the group C were superior to those in the group A and B, the differences were statistically significant (PP<0.05). After treatment, MCE showed that the Aβ value of the group aC was higher than that of the group A and B, the difference was statistically significant (P<0.05). The thrombolysis in myocardial infarction myocardial perfusion grade classification showed that the patients with grades 2‒3 were more abundant in the group C than the group A and B, the difference was statistically significant (PP<0.05). The incidences of MACEs, such as malignant arrhythmia, recurrent heart failure (HF), recurrent myocardial infarction, and death, in the group C were significantly lower than those in the group A and B (PP<0.05). CONCLUSIONS For AMI patients after PCI, alprostadil combined with tanshinone IIa injection can effectively improve microcirculation and ventricular remodeling, improve cardiac function and reduce the occurrence of MACEs. This combination can be widely used in clinical practice.
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Affiliation(s)
- Yang Lu
- Department of Cardiovascular Medicine, Affiliated Haian Hospital of Nantong University, Nantong, China.
| | - Yongjin Yan
- Department of Cardiovascular Medicine, Affiliated Haian Hospital of Nantong University, Nantong, China
| | - Xiaofeng Liu
- Department of Cardiovascular Medicine, Affiliated Haian Hospital of Nantong University, Nantong, China
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Moroi R, Shiga H, Tarasawa K, Yano K, Shimoyama Y, Kuroha M, Kakuta Y, Fushimi K, Fujimori K, Kinouchi Y, Masamune A. The clinical practice of ulcerative colitis in elderly patients: An investigation using a nationwide database in Japan. JGH Open 2021; 5:842-848. [PMID: 34386590 PMCID: PMC8341191 DOI: 10.1002/jgh3.12541] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/12/2021] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
Background and Aim The number of elderly patients with ulcerative colitis (UC) is increasing worldwide. The clinical practice of associated treatment is still unclear. Therefore, we aimed to analyze clinical treatment realities and mortality in elderly and non‐elderly patients with UC. Methods We collected UC patients' data using the diagnosis procedure combination (DPC) database system and divided eligible patients into elderly (≥65 years) and non‐elderly (≤64 years) groups. We investigated and compared their therapeutic histories (medical treatments vs. surgery). Logistic regression analysis was conducted to identify clinical factors affecting surgery and in‐hospital death in each group. Results The rates of systemic steroid injection, molecular targeting drug usage, and surgery were not different between the two age groups. Meanwhile, the rate of in‐hospital death in elderly patients was higher than that in non‐elderly patients (2.7% vs. 0.19%, P < 0.0001). Multivariate analysis revealed that lower body mass index, treatment at an academic hospital, smoking history, molecular targeting drug use, and treatment with systemic steroid injection affected the rate of surgery in the elderly group. Multivariate analysis also revealed that male and older age affected the rate of in‐hospital death in the elderly group. Similar tendencies were also recognized in the non‐elderly group. Conclusions The clinical practice of treating elderly patients with UC is overall not different from treating non‐elderly patients with UC. Although the form of medical treatment and surgery rate for elderly patients with UC may not be significantly different from non‐elderly patients, the rate of in‐hospital death for elderly patients is higher.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
| | - Hisashi Shiga
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy Tohoku University Graduate School of Medicine Sendai Japan
| | - Kota Yano
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
| | - Masatake Kuroha
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
| | - Yoichi Kakuta
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Tokyo Medical and Dental University Graduate School of Medicine Bunkyo Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy Tohoku University Graduate School of Medicine Sendai Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology Tohoku University Hospital Sendai Japan
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Toplak N, Pimpale Chavan P, Rosina S, Dallos T, Rotem Semo O, Aguiar CL, Khubchandani R, Ravelli A, Patwardhan A. Is Anti-NXP2 Autoantibody a Risk Factor for Calcinosis and Poor Outcome in Juvenile Dermatomyositis Patients? Case Series. Front Pediatr 2021; 9:810785. [PMID: 35280444 PMCID: PMC8904416 DOI: 10.3389/fped.2021.810785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022] Open
Abstract
Juvenile dermatomyositis (JDM) has a wide spectrum of clinical presentations. In the last decade, several myositis-specific antibodies have been identified in patients with JDM and connected with specific organ involvement or specific clinical picture. It has been published that the presence of anti-NXP2 autoantibodies presents a risk for calcinosis in patients with JDM. We aimed to investigate the prevalence of calcinosis and response to the treatment in JDM patients with anti-NXP2. In a retrospective, multinational, multicenter study, data on 26 JDM (19 F, 7 M) patients with positive anti-NXP2 were collected. The mean age at disease presentation was 6.5 years (SD 3.7), the median diagnosis delay was 4 months (range 0.5-27 months). Patients were divided into two groups (A and B) based on the presence of calcinosis, which occurred in 42% of anti-NXP2 positive JDM patients (group A). Four patients already had calcinosis at presentation, one developed calcinosis after 4 months, and 6 developed calcinosis later in the disease course (median 2 years, range 0.8-7.8). The differences in laboratory results were not statistically significant between the groups. The mean age at disease presentation (5.2/7.5 years) trended toward being younger in group A. Children with calcinosis were treated with several combinations of drugs. In four cases, rituximab and, in one case, anti-TNF alpha agents were used successfully. Disease outcome (by evaluation of the treating physician) was excellent in four, good in two, stable in two, and poor in three patients. None of the patients from group B had a poor disease outcome. In conclusion, JDM patients with anti-NXP2 are prone to develop calcinosis, especially if they present with the disease early, before 5 years of age. The development of calcinosis is associated with worse disease outcomes. The combination of several immunomodulatory drugs and biologic drugs can stop calcinosis progression; however, there are no evidence-based therapies for treating calcinosis in JDM patients.
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Affiliation(s)
- Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, Faculty of Medicine, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | | | - Silvia Rosina
- Pediatric Rheumatology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tomas Dallos
- Department of Paediatrics, Comenius University Medical School, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Oz Rotem Semo
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, United States
| | - Cassyanne L Aguiar
- Pediatric Rheumatology, Eastern Virginia Medical School (EVMS), Children's Hospital of The King's Daughters, Norfolk, VA, United States
| | | | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Universita Degli Studi di Genova, Genoa, Italy
| | - Anjali Patwardhan
- Pediatric Rheumatology, University of Missouri, School of Medicine, Columbia, MO, United States
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Spooren CE, Lodewick TM, Beelen EM, van Dijk DP, Bours MJ, Haans JJ, Masclee AA, Pierik MJ, Bakers FC, Jonkers DM. The reproducibility of skeletal muscle signal intensity on routine magnetic resonance imaging in Crohn's disease. J Gastroenterol Hepatol 2020; 35:1902-1908. [PMID: 32267571 PMCID: PMC7687168 DOI: 10.1111/jgh.15068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 03/25/2020] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Myosteatosis is a prognostic factor in cancer and liver cirrhosis. It can be determined noninvasively using computed tomography or, as shown recently, by magnetic resonance (MR) imaging. The primary aim was to analyze the reproducibility of skeletal muscle signal intensity on routine MR-enterographies, as indicator of myosteatosis, in Crohn's disease (CD) and to explore the association between skeletal muscle signal intensity at diagnosis with time to intestinal resection. METHODS CD patients undergoing MR-enterography within 6 months from diagnosis and having a maximum of 5 years follow-up were included. Skeletal muscle signal intensity was analyzed on T1-weighted fat-saturated post-contrast images. Intra-observer and inter-observer reproducibilities were assessed by intra-class correlation coefficient and Cohen's kappa. Intra-observer and inter-observer variabilities were determined by Pearson correlation coefficient and displayed by Bland-Altman plots. Time to intestinal resection was studied by Kaplan-Meier analysis. RESULTS Median time between diagnosis and MR-enterography was 5 weeks (inter-quartile range 1-9) in 35 CD patients. Skeletal muscle signal intensity showed good intra-class correlation and substantial agreement (for intra-observer, intraclass correlation coefficient = 0.948, κ = 0.677; and inter-observer reproducibility, intraclass correlation coefficient = 0.858, κ = 0.622). Resection free survival was shorter in the low skeletal muscle signal intensity group (P = 0.037). CONCLUSION Skeletal muscle signal intensity on routine MR-enterographies is reproducible and was associated with unfavorable disease outcome, indicating potential clinical relevance.
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Affiliation(s)
- Corinne E.G.M. Spooren
- Division of Gastroenterology–HepatologyMaastricht University Medical Centre+MaastrichtThe Netherlands,School for Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Toine M. Lodewick
- Department of Radiology and Nuclear MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Evelien M.J. Beelen
- Division of Gastroenterology–HepatologyMaastricht University Medical Centre+MaastrichtThe Netherlands
| | - David P.J. van Dijk
- School for Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht University Medical CentreMaastrichtThe Netherlands,Department of SurgeryMaastricht University Medical Centre+MaastrichtThe Netherlands
| | - Martijn J.L. Bours
- Department of Epidemiology, GROW School for Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Jeoffrey J. Haans
- Division of Gastroenterology–HepatologyMaastricht University Medical Centre+MaastrichtThe Netherlands
| | - Ad A.M. Masclee
- Division of Gastroenterology–HepatologyMaastricht University Medical Centre+MaastrichtThe Netherlands,School for Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Marie J. Pierik
- Division of Gastroenterology–HepatologyMaastricht University Medical Centre+MaastrichtThe Netherlands,School for Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - Frans C.H. Bakers
- Department of Radiology and Nuclear MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Daisy M.A.E. Jonkers
- Division of Gastroenterology–HepatologyMaastricht University Medical Centre+MaastrichtThe Netherlands,School for Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht University Medical CentreMaastrichtThe Netherlands
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Schlotawa L, Preiskorn J, Ahrens-Nicklas R, Schiller S, Adang LA, Gärtner J, Friede T. A systematic review and meta-analysis of published cases reveals the natural disease history in multiple sulfatase deficiency. J Inherit Metab Dis 2020; 43:1288-1297. [PMID: 32621519 DOI: 10.1002/jimd.12282] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 12/29/2022]
Abstract
Multiple Sulfatase Deficiency (MSD, MIM#272200) is an ultra-rare lysosomal storage disorder arising from mutations in the SUMF1 gene, which encodes the formylglycine-generating enzyme (FGE). FGE is necessary for the activation of sulfatases, a family of enzymes that are involved in the degradation of sulfated substrates such as glycosaminoglycans and sulfolipids. SUMF1 mutations lead to functionally impaired FGE and individuals with MSD demonstrate clinical signs of single sulfatase deficiencies, including metachromatic leukodystrophy (MLD) and several mucopolysaccharidosis (MPS) subtypes. Comprehensive information related to the natural history of MSD is missing. We completed a systematic literature review and a meta-analysis on data from published cases reporting on MSD. As available from these reports, we extracted clinical, genetic, biochemical, and brain imaging information. We identified 75 publications with data on 143 MSD patients with a total of 53 unique SUMF1 mutations. The mean survival was 13 years (95% CI 9.8-16.2 years). Seventy-five clinical signs and 11 key clusters of signs were identified. The most frequently affected organs systems were the nervous, skeletal, and integumentary systems. The most frequent MRI features were abnormal myelination and cerebral atrophy. Individuals with later onset MSD signs and survived longer than those with signs at birth. Less severe mutations, low disease burden and achievement of independent walking positively correlated with longer survival. Despite the limitations of our approach, we were able to define clinical characteristics and disease outcomes in MSD. This work will provide the foundation of natural disease history data needed for future clinical trial design.
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Affiliation(s)
- Lars Schlotawa
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Joana Preiskorn
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Rebecca Ahrens-Nicklas
- Division of Clinical Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stina Schiller
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Laura A Adang
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jutta Gärtner
- Department of Paediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
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Mulinari Turin de Oliveira N, Fernandes da Silva Figueiredo I, Cristine Malaquias da Silva L, Sauruk da Silva K, Regis Bueno L, Barbosa da Luz B, Rita Corso C, Paula Werner MF, Soares Fernandes E, Maria-Ferreira D. Tissue Proteases and Immune Responses: Influencing Factors of COVID-19 Severity and Mortality. Pathogens 2020; 9:E817. [PMID: 33036180 PMCID: PMC7600261 DOI: 10.3390/pathogens9100817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/18/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) is caused by the highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has affected the global population despite socioeconomic status and amazed surveillance agencies for its incidence, mortality, and recovery rates. COVID-19 affects all age groups; however, it is suggested to progress into severe disease and cause mortality in over 10% of the confirmed cases, depending on the individual characteristics of the affected population. One of the biggest unanswered questions it is why only some individuals develop into the severe stages of the disease. Current data indicate that most of the critically ill are the elderly or those with comorbidities such as hypertension, diabetes, and asthma. However, it has been noted that, in some populations, severe disease is mostly observed in much younger individuals (<60-years old) with no reported underlying medical conditions. Certainly, many factors may contribute to disease severity including intrinsic host factors such as genetic variants, the expression levels of tissue proteins, among others. Considering all these aspects, this review aims to discuss how the expression levels of tissue proteases and the different profiles of immune responses influence the susceptibility to COVID-19 as well as disease severity and outcome.
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Affiliation(s)
- Natália Mulinari Turin de Oliveira
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Isabella Fernandes da Silva Figueiredo
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Liziane Cristine Malaquias da Silva
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Karien Sauruk da Silva
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Laryssa Regis Bueno
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Bruna Barbosa da Luz
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR 81531-980, Brazil; (B.B.d.L.); (M.F.P.W.)
| | - Cláudia Rita Corso
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Maria Fernanda Paula Werner
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR 81531-980, Brazil; (B.B.d.L.); (M.F.P.W.)
| | - Elizabeth Soares Fernandes
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
| | - Daniele Maria-Ferreira
- Faculdades Pequeno Príncipe, Av. Iguaçu No 333, Curitiba, PR 80250-200, Brazil; (N.M.T.d.O.); (I.F.d.S.F.); (L.C.M.d.S.); (K.S.d.S.); (L.R.B.); (C.R.C.); (E.S.F.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim No 1532, Curitiba, PR 80250-200, Brazil
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Peters JS, Ismail N, Dippenaar A, Ma S, Sherman DR, Warren RM, Kana BD. Genetic Diversity in Mycobacterium tuberculosis Clinical Isolates and Resulting Outcomes of Tuberculosis Infection and Disease. Annu Rev Genet 2020; 54:511-537. [PMID: 32926793 DOI: 10.1146/annurev-genet-022820-085940] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tuberculosis claims more human lives than any other bacterial infectious disease and represents a clear and present danger to global health as new tools for vaccination, treatment, and interruption of transmission have been slow to emerge. Additionally, tuberculosis presents with notable clinical heterogeneity, which complicates diagnosis, treatment, and the establishment of nonrelapsing cure. How this heterogeneity is driven by the diversity ofclinical isolates of the causative agent, Mycobacterium tuberculosis, has recently garnered attention. Herein, we review advances in the understanding of how naturally occurring variation in clinical isolates affects transmissibility, pathogenesis, immune modulation, and drug resistance. We also summarize how specific changes in transcriptional responses can modulate infection or disease outcome, together with strain-specific effects on gene essentiality. Further understanding of how this diversity of M. tuberculosis isolates affects disease and treatment outcomes will enable the development of more effective therapeutic options and vaccines for this dreaded disease.
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Affiliation(s)
- Julian S Peters
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg 2000, South Africa; ,
| | - Nabila Ismail
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; ,
| | - Anzaan Dippenaar
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; , .,Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, 2000, Belgium;
| | - Shuyi Ma
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington 98109, USA; ,
| | - David R Sherman
- Department of Microbiology, University of Washington School of Medicine, Seattle, Washington 98109, USA; ,
| | - Robin M Warren
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; ,
| | - Bavesh D Kana
- Department of Science and Innovation-National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, Johannesburg 2000, South Africa; ,
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Tezcan M, Dogan Gokce G, Sen N, Zorlutuna Kaymak N, Ozer R. Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients. New Microbes New Infect 2020; 37:100753. [PMID: 32904987 PMCID: PMC7462442 DOI: 10.1016/j.nmni.2020.100753] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
Electrolyte abnormalities are not uncommon in coronavirus disease 2019 (COVID-19). Several studies have suggested that various electrolyte imbalances seem to have an impact on disease prognosis. However, no study has primarily focused on the effect of baseline electrolyte abnormalities on disease outcome. In this study, we assessed the validity of the hypothesis that baseline electrolyte imbalances may be related to unfavourable outcomes in hospitalized COVID-19 patients. Design of the study was retrospective and observational. We included 408 hospitalized individuals with COVID-19 over 18 years old. Baseline levels of sodium, potassium, calcium and chloride were assessed and the effects of abnormalities in these electrolytes on requirement for intensive care unit and mechanical ventilation, hospitalization duration and treatment outcome were evaluated. Patients were clustered based on electrolyte levels and clusters were compared according to outcome variables. Frequency of other severe disease indices was compared between the clusters. Lastly, we evaluated the independent factors related to COVID-19-associated deaths with multivariate analyses. In all, 228 (55.8%) of the patients had at least one electrolyte imbalance at baseline. Hyponatraemia was the most frequent electrolyte abnormality. Patients with hyponatraemia, hypochloraemia or hypocalcaemia had, respectively, more frequent requirement for intensive care unit and mechanical ventilation, higher mortality rate and longer hospitalization. The clusters associated with electrolyte abnormalities had unfavourable outcomes. Also, Clinical and laboratory features associated with severe disease were detected more often in those clusters. Hyponatraemia was an independent factor related to death from COVID-19 (OR 10.33; 95% CI 1.62-65.62; p 0.01). Furthermore, baseline electrolyte imbalances, primarily hyponatraemia, were related to poor prognosis in COVID-19 and baseline electrolyte assessment would be beneficial for evaluating the risk of severe COVID-19.
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Affiliation(s)
- M.E. Tezcan
- Department of Rheumatology, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - G. Dogan Gokce
- Department of Ophthalmology, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N. Sen
- Department of Rheumatology, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - N. Zorlutuna Kaymak
- Department of Ophthalmology, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - R.S. Ozer
- Department of Infectious Diseases, Kartal Dr Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Tanno L, Pea A, Nykänen T, Prasad P, Tuncer C, Marchegiani G, Robinson S. Role of Pre-operative Inflammatory Markers as Predictors of Lymph Node Positivity and Disease Recurrence in Well-Differentiated Pancreatic Neuroendocrine Tumours: Pancreas2000 Research and Educational Program (Course 9). Front Med (Lausanne) 2020; 7:346. [PMID: 32850881 PMCID: PMC7431465 DOI: 10.3389/fmed.2020.00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/10/2020] [Indexed: 11/13/2022] Open
Abstract
Pancreatic neuroendocrine tumours (PNET) is a rare disease and in the absence of metastases, surgical resection is recommended. Key factors affecting survival in PNETs are the stage and grade of the disease, but there is increasing evidence suggesting lymph node involvement is associated with shorter disease-free and overall survival. Ability to predict the likelihood of lymph node involvement at the time of diagnosis would affect surgical decision making in these patients. A systemic inflammatory index such as neutrophil to lymphocyte ratio or platelet to lymphocyte ratio has been associated with poor prognosis in several cancers. Method: This study is a retrospective multi-centre study. The data including pre-operative inflammatory markers such as haemoglobin, neutrophil, lymphocyte counts and pathological data including number of positive lymph nodes, tumour grade and size, are collected to assess the association between inflammatory index and lymph node involvement. Conclusion: This study aims to assess the value of routinely available pre-operative haematological markers in predicting lymph node involvement in non-functioning PNETs.
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Affiliation(s)
- Lulu Tanno
- Department of General Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Antonio Pea
- Pancreas Institute, University Hospital of Verona (AOUI), Verona, Italy
| | - Taina Nykänen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland
| | - Pooja Prasad
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Ceren Tuncer
- School of Medicine, Koç University Research Centre for Translational Medicine, Istanbul, Turkey
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Yu J, Wu J, Huang O, He J, Zhu L, Chen W, Li Y, Chen X, Shen K. Clinicopathological characteristics, adjuvant chemotherapy decision and disease outcome in patients with breast cancer with a 21-gene recurrence score of 26-30. Oncol Lett 2020; 20:1545-1556. [PMID: 32724396 PMCID: PMC7377026 DOI: 10.3892/ol.2020.11734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/26/2020] [Indexed: 12/19/2022] Open
Abstract
Recurrence score (RS) could be used to predict clinical outcomes and chemotherapy efficacy in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative and lymph node-negative breast cancer. However, the clinical features and management of patients with an RS of 26–30 are not completely understood. In the present study, 783 patients with HR+/HER2−, lymph node-negative early breast cancer and RS ≥18 were included and categorized into RS=18−25 (47.8%), 26–30 (25.5%) or ≥31 (26.7%) groups. Clinicopathological characteristics, adjuvant chemotherapy usage and disease outcomes were compared. Alterations in the adjuvant chemotherapy recommendation after 21-gene RS testing were also analyzed. The results indicated that patients with RS=26−30 had higher progesterone receptor (PR) expression [odds ratio (OR)=2.84; P<0.001] and lower Ki-67 index (OR, 1.88; P=0.032) compared with patients with RS ≥31. Multivariate analysis demonstrated that age ≤50 years (OR, 5.75; P=0.001) and luminal-B subtype (OR, 7.75; P<0.001) were factors that were independently associated with chemotherapy usage in the RS=26−30 group. Among 104 patients who were not recommended chemotherapy before 21-gene RS testing, the treatment decision for 52 patients was changed to recommend chemotherapy once an RS of 26–30 was identified. The patient adherence rate to the treatment recommendation was 95.0% (190/200). After a median follow-up of 21.5 months, 6 patients displayed disease recurrence in the RS=26−30 group, and there was no significant difference between patients receiving chemotherapy and patients not receiving chemotherapy. In conclusion, patients with RS=26−30 had tumors with higher PR expression and lower Ki-67 index compared with those of patients with RS ≥31. Age, luminal subtype and RS testing influenced chemotherapy usage in patients with RS=26−30; however, no significant benefit from adjuvant chemotherapy was observed in a short term of 2 years.
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Affiliation(s)
- Jing Yu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jiayi Wu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Ou Huang
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Jianrong He
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Li Zhu
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Weiguo Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Yafen Li
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaosong Chen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Kunwei Shen
- Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
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Szymańska E, Lipiński P, Rokicki D, Książyk J, Tylki-Szymańska A. Over 20-Year Follow-up of Patients with Hepatic Glycogen Storage Diseases: Single-Center Experience. Diagnostics (Basel) 2020; 10:E297. [PMID: 32414085 DOI: 10.3390/diagnostics10050297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The published data on the long-term outcomes of glycogen storage disease (GSD) patients is sparse in the literature. The aim of this study was to analyze the long-term (over 20 years) follow-up of patients with hepatic types of GSD-I, III, VI, and IX-from childhood to adulthood, managed by one referral center. PATIENTS AND METHODS Thirty adult patients with hepatic GSD were included in the study. A retrospective chart review of patients' medical records has been performed. RESULTS During the long-term follow-up, the most frequent complications observed in a group of 14 GSD I patients were nephropathy with blood hypertension (10/14), hyperuricemia (8/14), and development of hepatocellular adenomas (HCA; 5/14). All individuals but four presented with normal height. Two patients with GSD Ib suffered from inflammatory bowel disease (IBD). Nine (64%) GSD I patients were in balanced metabolic condition at the age of 18. Regarding GSD III/VI/IX, the most frequent complication was short stature observed in 5 out of 16 patients. All patients but one with GSD VI were in balanced metabolic condition at the age of 18. CONCLUSION The long-term outcomes of patients with GSD depend mainly on proper (adjusted to each type of GSD) dietary management and patient compliance. However, in GSD type I, even proper management does not eliminate all long-term complications in adulthood.
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Tong Y, Wu J, Huang O, He J, Zhu L, Chen W, Li Y, Chen X, Shen K. IGF-1 Interacted With Obesity in Prognosis Prediction in HER2-Positive Breast Cancer Patients. Front Oncol 2020; 10:550. [PMID: 32391265 PMCID: PMC7193870 DOI: 10.3389/fonc.2020.00550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 03/26/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose: Dysmetabolism and high circulating insulin-like growth factor 1 (IGF-1) would increase breast cancer risk, but its association with survival in HER2+ breast cancer patients has not been well-studied. Herein, we aim to evaluate the prognostic value of IGF-1 and metabolic abnormalities in HER2+ population. Patients and Methods: HER2+ breast cancer patients treated in Ruijin Hospital between November 2012 and June 2017 were retrospectively analyzed. Median value of circulating IGF-1 was adopted to classify low or high IGF-1 group. Metabolic syndrome (MetS) was defined using AHA/NHLBI criteria. Overweight was defined by body mass index (BMI) ≥ 24.0 kg/m2 in Chinese population. Results: Overall, 679 patients were included and 209 had synchronous MetS. High IGF-1 level was more common in pre/peri-menopausal women (P < 0.001) and high IGFBP-3 patients (P < 0.001). After a median follow-up of 36 months, 52 patients had disease recurrences. IGF-1 level was not associated with recurrence-free survival (RFS, P = 0.620) in the whole population. However, exploratory subgroup analysis found that BMI and IGF-1 interacted in predicting RFS (P = 0.009). For non-overweight patients, high IGF-1 showed a superior 4-years RFS (91.1 vs. 85.0%; HR 0.53, 95% CI 0.27–1.00, P = 0.049) compared with patients with low IGF-1 level. In contrast, for overweight patients, high IGF-1 was associated with an impaired 4-years RFS (88.3 vs. 95.7%, HR 3.20, 95% CI 1.00–10.21, P = 0.038). Furthermore, high IGF-1 level was independently associated with better OS in the whole (HR 0.26, 95% CI 0.08–0.82, P = 0.044) as well as non-overweight population (HR 0.15, 95% CI 0.03–0.68, P = 0.005). Conclusions: IGF-1 level was not associated with RFS in HER2+ breast cancer patients. However, IGF-1 and BMI had significant interaction in disease outcome prediction in HER2+ patients. High IGF-1 was protective in non-overweight patients, but risk factor for those overweight, which deserves further evaluation.
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Affiliation(s)
- Yiwei Tong
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Wu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ou Huang
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianrong He
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhu
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiguo Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yafen Li
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaosong Chen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kunwei Shen
- Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Forni D, Sironi M. Population structure of Lassa Mammarenavirus in West Africa. Viruses 2020; 12:E437. [PMID: 32294960 DOI: 10.3390/v12040437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/07/2020] [Accepted: 04/10/2020] [Indexed: 01/01/2023] Open
Abstract
Lassa mammarenavirus (LASV) is the etiologic agent of Lassa fever. In endemic regions in West Africa, LASV genetic diversity tends to cluster by geographic area. Seven LASV lineages are recognized, but the role of viral genetic determinants on disease presentation in humans is uncertain. We investigated the geographic structure and distribution of LASV in West Africa. We found strong spatial clustering of LASV populations, with two major east–west and north–south diversity gradients. Analysis of ancestry components indicated that known LASV lineages diverged from an ancestral population that most likely circulated in Nigeria, although alternative locations, such as Togo, cannot be excluded. Extant sequences carrying the largest contribution of this ancestral population include the prototype Pinneo strain, the Togo isolates, and a few viruses isolated in Nigeria. The LASV populations that experienced the strongest drift circulate in Mali and the Ivory Coast. By focusing on sequences form a single LASV sublineage (IIg), we identified an ancestry component possibly associated with protection from a fatal disease outcome. Although the same ancestry component tends to associate with lower viral loads in plasma, the small sample size requires that these results are treated with extreme caution.
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Olliges E, Burgdorf C, Ladwig KH, Moeller C, Deftu-Kloes D, Pohl S, Ruettner B, Richardt G, Meissner K, Steger A, Goetzmann L, Ronel J. Psychosocial and physical long-term outcome in patients with a history of takotsubo cardiomyopathy or myocardial infarction - a multi-centered case control study. PSYCHOL HEALTH MED 2020; 25:989-1003. [PMID: 32000523 DOI: 10.1080/13548506.2020.1722315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Physical long-term impacts of Takotsubo Cardiomyopathy (TTC) remain controversial and an underestimation of their severity becomes increasingly evident. Even less is known about mental long-term impacts of TTC. This study aims at a better understanding of the physical and mental long-term effects of TTC in comparison to myocardial infarctions (MI). On average 5 years after disease onset, 68 TTC patients and 68 age- and sex-matched MI patients were assessed for disease-related quality of life, depression, anxiety, chronic stress, social support, resilience, and life events prior to disease onset. Scores of TTC and MI patients were compared to each other and to normative references values. Regression analyses were used to evaluate the predictive value of the number of life events prior to disease onset for physical and mental long-term outcomes. Both groups displayed higher scores in depression and anxiety, higher levels of chronic stress, and lower scores in physical and mental quality of life in comparison to norm samples, while social support did not differ from norms. No differences between the two patient groups were observed. Within both groups, the majority of patients (TTC: 69.1%; MI: 60.3%) reported stressful life events prior to disease onset. In TTCs and MIs, the number of events had a significant impact on long-term mental health and chronic stress. Notably, both patient collectives scored higher in resilience than healthy controls. Results suggest negative long-term impacts of TTC on mental and physical wellbeing, comparable to those of MI. Besides a good somatic-medical care, psychotherapeutic support, including the development of functional coping strategies, might be warranted for TTC patients. The long-term impact of TTC should be taken as serious as that of MI.
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Affiliation(s)
- E Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - C Burgdorf
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen , Bad Bevensen, Germany
| | - K H Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Epidemiology II, Helmholtz Zentrum , Munich, Germany
| | - C Moeller
- Medical Clinic II, Luebeck, Universitaetsklinikum Schleswig-Holstein , Germany
| | - D Deftu-Kloes
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - S Pohl
- Psychiatric Day-care Hospital, Klinikum Frankfurt (Oder) , Frankfurt Oder, Germany
| | - B Ruettner
- Department of Psychology, Medical School Hamburg , Germany
| | - G Richardt
- Department of Cardiology, Segeberger Kliniken , Bad Segeberg, Germany
| | - K Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich , Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences , Coburg, Germany
| | - A Steger
- Klinik und Poliklinik fuer Innere Medizin I, Klinikum rechts der Isar, Technische Universitaet Muenchen , Munich, Germany
| | - L Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken , Bad Seg- eberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Techni- sche Universitaet Muenchen , Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG , Barmel- weid, Switzerland
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Grob L, Bluemel S, Biedermann L, Fournier N, Rossel JB, Vavricka SR, Zeitz J, Rogler G, Stallmach A, Scharl M. Effect of distance to specialist care for the diagnosis and disease outcome of inflammatory bowel disease in the Swiss inflammatory bowel disease cohort study. Therap Adv Gastroenterol 2020; 13:1756284819895217. [PMID: 32047533 PMCID: PMC6984432 DOI: 10.1177/1756284819895217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) needs early interventions and an individual specialist-patient relationship. Distance from a tertiary IBD center might affect patient's disease course and outcome. We investigated whether the patient-to-specialist distance has an impact on the disease course using the well-defined patient collective of the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). METHODS Patient's home address at diagnosis (postal zip code) was extracted from the SIBDCS database. Distance between each zip code and the nearest located IBD specialist center was calculated and classified into the following three sections based on proximity: <10 km (group 1); 10-35 km (group 2); >35 km (group 3). RESULTS Our study included in total 408 IBD patients [234 Crohn's disease (CD), 154 ulcerative colitis (UC), 20 IBD unclassified (IBDU)]. Median age was lowest in group 2 at diagnosis (G1: 28 years; G2: 21 years, G3: 26 years, p < 0.01). The diagnostic delay did not differ between groups. CD patients in group 1 were treated more often with anti-tumor necrosis factor (TNF) agents (72% versus 56%, p = 0.04) and 5-aminosalicylates (44% versus 28%, p = 0.04) than in group 3. UC/IBDU patients in group 1 were treated more often with corticosteroids than patients in group 3 (83% versus 58%, p < 0.01). The occurrence of IBD-related surgeries did not differ between groups. CONCLUSIONS Patient-to-specialist distance might affect drug treatment. However, disease course and the need for IBD-related surgery does not seem to be associated with a longer distance to specialist care in Switzerland.
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Affiliation(s)
| | | | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Fournier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jean-Benoit Rossel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stephan R. Vavricka
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Zeitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland Center of Gastroenterology, Clinic Hirslanden Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Stallmach
- Department of Internal Medicine IV, University Hospital Jena, Jena, Germany
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Shah A, Sabir S, Artani M, Salam O, Khan S, Rizwan A. Significance of Hyponatremia as an Independent Factor in Predicting Short-term Mortality in Patients with Hemorrhagic Stroke. Cureus 2019; 11:e4549. [PMID: 31275773 PMCID: PMC6592831 DOI: 10.7759/cureus.4549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Hyponatremia is the most common electrolyte imbalance in patients with acute cerebrovascular insults. In patients with acute non-traumatic hemorrhagic stroke, the role of hyponatremia as a negative prognostic indicator has been controversial. The aim of this study is to evaluate the frequency of hyponatremia in patients with hemorrhagic stroke and determine its impact on their in-hospital disease outcome. Methods This was a prospective observational study, which included all patients with non-traumatic hemorrhagic stroke. Serum sodium concentration <135 mmol/L was labeled as hyponatremia. The etiology of hyponatremia was determined as syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS). The outcome was categorized as “complete recovery,” “motor/sensory deficit but not wheelchair/bed bound,” “wheelchair/bed bound,” and “in-hospital mortality.” SPSS for Windows version 22.0 (IBM Corp., Armonk, NY, US) was used to analyze the data. Results Out of 234 patients of hemorrhagic stroke, 45.3% (n=106) were hyponatremic, 58.5% had SIADH and 41.5% had CSWS. The overall mortality rate of hemorrhagic stroke was 16.2%. The mortality rate was 36.5% in the SIADH group, 50% in the CSWS group, and 13.1% in the normonatremic group (p<0.00001). The mean hospital stay in the SIADH group was 7.04 ± 2.57, in the CSWS group, it was 6.50 ± 1.55, and in the normonatremic group, it was 3.88 ± 2.74 (p=0.000). Conclusion Hyponatremia is an independent predictor of short-term mortality in patients with acute hemorrhagic stroke.
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Affiliation(s)
- Ali Shah
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Samurna Sabir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Moiz Artani
- Community Health Sciences, Jinnah Medical and Dental College, Karachi, PAK
| | - Osama Salam
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Shehroz Khan
- Community Health Sciences, Jinnah Medical and Dental College, Karachi, PAK
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Mori M, Leitman E, Walker B, Ndung’u T, Carrington M, Goulder P. Impact of HLA Allele-KIR Pairs on HIV Clinical Outcome in South Africa. J Infect Dis 2019; 219:1456-1463. [PMID: 30520960 PMCID: PMC6467198 DOI: 10.1093/infdis/jiy692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/30/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND HLA class I contributes to HIV immune control through antigen presentation to cytotoxic T lymphocytes (CTLs) and natural killer (NK) cells. In contrast to investigations of CTL, studies of NK cells in HIV control through HLA-killer immunoglobulin-like receptor (KIR) interactions remain sparse in African cohorts. METHODS Treatment-naive, chronically HIV-infected adults (N = 312) were recruited from South Africa, and the effects of HLA-KIR pairs on clinical outcome were analyzed. RESULTS There was no significant difference in viral load among all subjects with HLA alleles from the HLA-C1 group (P = .1). However, differences in HLA-C type significantly influenced viremia among 247 KIR2DL3 positives (P = .04), suggesting that specific HLA-KIR interactions contribute to immune control. Higher viral load (P = .02) and lower CD4+ T-cell counts (P = .008) were observed in subjects with HLA-C*16:01+KIR2DL3+. Longitudinal analysis showed more rapid progression to AIDS among HLA-C*16:01+KIR2DL3+ subjects (adjusted hazard ratio 1.9, P = .03) than those without this genotype, independent of CD4+ T-cell count and viral load. CONCLUSIONS These results highlight the existence of unique anti-HIV innate immunity within distinct populations and the contribution of KIR on NK cells and some CTLs to the well-described HLA-mediated impact on HIV disease progression.
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Affiliation(s)
- Masahiko Mori
- Department of Paediatrics, University of Oxford
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Japan
| | | | - Bruce Walker
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Cambridge
| | - Thumbi Ndung’u
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Cambridge
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal
- Africa Health Research Institute, Durban, South Africa
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Mary Carrington
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Cambridge
- Cancer and Inflammation Program, Frederick National Laboratory for Cancer Research, Maryland
| | - Philip Goulder
- Department of Paediatrics, University of Oxford
- HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal
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Yadegar A, Mohabati Mobarez A, Zali MR. Genetic diversity and amino acid sequence polymorphism in Helicobacter pylori CagL hypervariable motif and its association with virulence markers and gastroduodenal diseases. Cancer Med 2019; 8:1619-1632. [PMID: 30873747 PMCID: PMC6488209 DOI: 10.1002/cam4.1941] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/22/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Genetic variability in cagL gene especially within the Helicobacter pylori CagL hypervariable motif (CagLHM) may affect the development of gastric cancer. Therefore, this study was conducted to investigate the association of CagL diversity with clinical outcomes and with H pylori virulence markers. A total of 126 patients with different gastric diseases including non-ulcer dyspepsia (NUD), peptic ulcer disease (PUD), gastric erosion (GE), and gastric cancer (GC) were enrolled. H pylori was cultured from gastric biopsies, and the isolates were screened for the presence of cagL, cagA, vacA, babA2, sabA, and cagPAI integrity by PCR. The amino acid polymorphisms of cagL were analyzed using DNA sequencing. We isolated 61 (48.4%) H pylori strains from 36 NUD, eight PUD, 12 GE, and five GC patients. Almost all isolates were cagL positive (97%), and their RGD, RHS, and SKIIVK motifs were highly conserved. Among 10 CagLHM variants identified, NEIGQ and NKIGQ were detected as the most prevalent sequences. Interestingly, a significant association was found between the presence of NKMGK and PUD (P = 0.002). Notably, the NEIGQ isolates with multiple C-type EPIYA repeat that carried intact cagPAI correlated with disease risk for PUD, GE, and GC (P = 0.021). In conclusion, we identified novel variants of H pylori CagLHM sequences in Iranian population such as NKMGK, which was associated with disease risk for PUD. Further studies using a large number of strains are required to better clarify the function of certain CagLHM motifs in gastric carcinogenesis and disease outcome.
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Affiliation(s)
- Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ashraf Mohabati Mobarez
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Koc ÖM, Robaeys G, Yildirim B, Posthouwer D, Hens N, Koek GH. The influence of ethnicity on disease outcome in patients with chronic hepatitis B infection. J Med Virol 2018; 91:623-629. [PMID: 30381836 PMCID: PMC6587848 DOI: 10.1002/jmv.25353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Abstract
Since the cultural diversity in Western Europe is growing, this study assessed whether foreign‐born chronic hepatitis B (CHB) patients have more cirrhosis than Dutch‐ or Belgian‐born patients, with a main focus on the Turkish population. Baseline characteristics (eg, socioeconomic status [SES]), biological characteristics, and disease outcome (eg, cirrhosis) were collected for all patients. Between December 2009 and January 2015, 269 CHB patients participated from the outpatient departments of three hospitals in the Netherlands, Belgium, and Turkey. Out of the 269 CHB patients, 210 were foreign‐born and 59 were Dutch‐ or Belgian‐born. Compared with Dutch‐ or Belgian‐born patients, foreign‐born patients had a higher prevalence of low SES (58% vs 31%; P = 0.001) and cirrhosis (27% vs 10%; P = 0.007). Among the Turkish population, there were no significant differences regarding the prevalence of low SES (73% vs 61%; P = 0.170), alcohol abuse (1% vs 5%; P = 0.120), anti‐hepatitis C virus positivity (4% vs 0%; P = 0.344), anti‐hepatitis D virus positivity (1% vs 6%; P = 0.297), and cirrhosis (37% vs 27%; P = 0.262) between patients (n = 102) living in Turkey (local) and Turkish CHB (n = 38) patients living in the Netherlands or Belgium (immigrant). In multivariate analysis, low SES (odds ratio, 5.7; 95% confidence interval, 2.3‐14.5; P < 0.001) was associated with cirrhosis. In this study, foreign‐born CHB patients were associated with more advanced HBV‐related liver disease with 27% having cirrhosis. However, ethnicity was not associated with cirrhosis when SES was included in the multivariate analysis. The similar prevalence of cirrhosis in local Turkish compared to immigrant Turkish CHB patients is novel and warrants further investigation. Foreign‐born individuals have a higher prevalence of cirrhosis than Dutch‐ or Belgian‐ born individuals There was a lower socioeconomic status in the foreign‐born individuals No difference in the prevalence of cirrhosis was seen between the local and immigrant Turkish population Socioeconomic status and not ethnicity was an independent predictor of cirrhosis
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Affiliation(s)
- Özgür M Koc
- Department of Internal Medicine, Infectious Diseases and Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, The Netherlands.,Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Hepatology, UZ Leuven, Leuven, Belgium
| | - Beytullah Yildirim
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Dirk Posthouwer
- Department of Internal Medicine, Infectious Diseases and Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium.,Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Ger H Koek
- School of Nutrition and Translational Research in Metabolism, University Maastricht, Maastricht, The Netherlands.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Surgery, University Hospital of the RWTH, Aachen, Germany
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Abstract
BACKGROUND Acute fatty liver of pregnancy (AFLP) is a serious disease with high mortality. Recent data suggest that postpartum application of artificial liver support therapy (ALST) in AFLP management improves disease outcome. In current study, we tend to further evaluate whether the type, the timing, and the number of postpartum ALST sessions and other clinical factors including complications and liver and renal function will influence disease outcome in ALST era. METHODS Medical records of 15 AFLP patients having postpartum ALST in our hospital from 2010 to 2016 were first retrospectively reviewed. A systematic review and statistical analysis was then conducted with our cases and those having postpartum ALST reported in PubMed, Embase, Cochrane, and ClinicalTrials.gov till the end of June 2016. RESULTS Nine relevant studies were identified in the public databases. A total of 104 cases were enrolled for analysis including 15 cases from our hospital and 89 cases from the identified 9 studies. Univariate analysis revealed that 2 complications, postpartum hemorrhage and multiple organ dysfunctions (MODS), were associated with the outcome of AFLP patients undergoing postpartum ALST. Binary logistic regression analysis further indicated that MODS was the only independent factor affecting disease outcome. Surprisingly, factors including pre-ALST serum levels of total bilirubin and creatinine, the type and number of postpartum ALST sessions, time interval between delivery and ALST were unrelated to disease outcome. CONCLUSION Current data suggest that postpartum ALST improves the outcome of AFLP patients but more properly designed experiments are needed to confirm this point. Our study further indicates that occurrence of MODS carries a bad prognosis even in ALST era. Our study provides valuable information on guiding the clinical application of postpartum ALST in AFLP management.
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Affiliation(s)
- Zhenping Wu
- Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University
| | - Peng Huang
- Department of Epidemiology, School of Public Health, Nanchang University
| | - Yi Gong
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Junhui Wan
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Wei Zou
- Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University
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Buhl S, Kristina Borghede M, Brynskov J, Steenholdt C, Rasmussen M, Andrew Ainsworth M. Outcome of continued infliximab therapy in Crohn's disease patients with response but without remission after one year of infliximab - a retrospective cohort study. Scand J Gastroenterol 2018; 53:930-937. [PMID: 29987951 DOI: 10.1080/00365521.2018.1481519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Optimal management of Crohn's disease patients having responded to infliximab but without achieving remission is not well defined. The present study examined if these patients benefit from continued long-term infliximab maintenance therapy. METHOD Retrospective cohort study including all patients treated with infliximab for 1 year until the end of 2017 who have had a response but not reached remission on infliximab. Clinical outcomes were defined by the physicians' global evaluation, supported by clinical indices and objective markers of disease activity. RESULTS In total, 376 Crohn's disease patients received infliximab. Among these, 76 (20%) were classified as having response but non-remission (RNR) after 1 year of therapy. A great majority (n = 54; 71%) experienced no additional therapeutic benefit after a further year of infliximab maintenance therapy, thus still having RNR. Nineteen patients (25%) obtained remission during continued infliximab, whereas only 4% (n = 3) experienced treatment failure. Although infliximab therapy beyond 2 years (follow-up median 35 months, IQR: 23-55) was accompanied by a higher proportion attaining remission (40%), nearly half (46%) still failed to improve. Among patients who had discontinued infliximab while having RNR (n = 21), half (n = 11) experienced disease flare within five months (median 22 weeks, IQR: 12-31). CONCLUSION Most patients (71%) had no additional therapeutic benefit after an additional year of infliximab therapy, and after a median maintenance infliximab treatment period of 3 years, half still failed to improve further. Considering the importance of achieving complete remission, these patients appear to have an unmet medical need.
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Affiliation(s)
- Sine Buhl
- a Department of Gastroenterology , Herlev and Gentofte Hospital , Herlev , Denmark
| | | | - Jørn Brynskov
- a Department of Gastroenterology , Herlev and Gentofte Hospital , Herlev , Denmark
| | - Casper Steenholdt
- a Department of Gastroenterology , Herlev and Gentofte Hospital , Herlev , Denmark
| | - Maria Rasmussen
- a Department of Gastroenterology , Herlev and Gentofte Hospital , Herlev , Denmark
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Sehrawat S, Kumar D, Rouse BT. Herpesviruses: Harmonious Pathogens but Relevant Cofactors in Other Diseases? Front Cell Infect Microbiol 2018; 8:177. [PMID: 29888215 PMCID: PMC5981231 DOI: 10.3389/fcimb.2018.00177] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/08/2018] [Indexed: 11/24/2022] Open
Abstract
Most vertebrates are infected with one or more herpesviruses and remain so for the rest of their lives. The relationship of immunocompetent healthy host with herpesviruses may sometime be considered as harmonious. However, clinically severe diseases can occur when host immunity is compromised due to aging, during some stress response, co-infections or during neoplastic disease conditions. Discord can also occur during iatrogenic immunosuppression used for controlling graft rejection, in some primary genetic immunodeficiencies as well as when the virus infects a non-native host. In this review, we discuss such issues and their influence on host-herpesvirus interaction.
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Affiliation(s)
- Sharvan Sehrawat
- Department of Biological Sciences, Indian Institute of Science Education and Research Mohali, Mohali, India
| | - Dhaneshwar Kumar
- Department of Biological Sciences, Indian Institute of Science Education and Research Mohali, Mohali, India
| | - Barry T Rouse
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Sciences, The University of Tennessee, Knoxville, Knoxville, TN, United States
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46
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Slutzky-Shraga I, Gorshtein A, Popovitzer A, Robenshtok E, Tsvetov G, Akirov A, Hirsch D, Benbassat C. Clinical characteristics and disease outcome of patients with non-medullary thyroid cancer and brain metastases. Oncol Lett 2018; 15:672-676. [PMID: 29387239 PMCID: PMC5768058 DOI: 10.3892/ol.2017.7325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/22/2017] [Indexed: 11/07/2022] Open
Abstract
Brain metastases from non-medullary thyroid carcinoma (NMTC) are rare, with a reported frequency of ~1%, and patient survival time is <1 year after diagnosis. The optimal management of brain metastases in this setting continues to be debated. The aim of the present study was to evaluate a series of patients with brain metastases from NMTC attending a single tertiary medical center. The electronic database of Rabin Medical Center was reviewed for all patients with NMTC and distant metastases who were diagnosed and treated between 1970 and 2014. Those with brain metastases were identified and formed the study group. Data were collected from medical records comprising clinicopathological characteristics, time intervals for diagnosis and treatment, treatment modalities and outcome. Of the 172 patients with NMTC and distant metastases, 10 possessed brain metastases. These included 6 females and 4 males of median age 53.5 years (range, 18–81 years). All patients had lung metastases and 7 demonstrated bone metastases. The median interval between the diagnoses of NMTC and brain metastases was 40 months (range, 9–207 months). Of the 10 patients, 1 presented with brain metastases at primary diagnosis. Treatment of the brain metastases consisted of surgery, radiotherapy (external beam, stereotactic), and radioiodine, alone or in combination. A total of 2 patients received tyrosine kinase inhibitors. The median overall survival time from diagnosis of brain metastasis was 15 months. A total of 2 patients remained alive at the last follow-up (32 and 300 months, respectively). The present study demonstrated that brain metastases may occur in ≤6% of patients with NMTC and distant metastases. Brain metastases rarely present at diagnosis of NMTC and are associated with metastases in other distant sites. Systematic screening for brain metastases requires consideration in all patients with NMTC and distant metastases. Some patients show an indolent evolution with overall survival of >2 years, supporting an aggressive treatment approach.
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Affiliation(s)
- Ilana Slutzky-Shraga
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alex Gorshtein
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Aharon Popovitzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,ENT Oncology Clinic, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel
| | - Eyal Robenshtok
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.,ENT Oncology Clinic, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel
| | - Gloria Tsvetov
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amit Akirov
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Dania Hirsch
- Endocrine Institute, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Carlos Benbassat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Endocrine Institute, Assaf HaRofeh Medical Center, Zerifin 70300, Israel
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Duong VT, Tuyen HT, Van Minh P, Campbell JI, Phuc HL, Nhu TDH, Tu LTP, Chau TTH, Nhi LTQ, Hung NT, Ngoc NM, Huong NTT, Vi LL, Thompson CN, Thwaites GE, de Alwis R, Baker S. No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting. Clin Infect Dis 2018; 66:504-511. [PMID: 29029149 PMCID: PMC5850041 DOI: 10.1093/cid/cix844] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022] Open
Abstract
Background Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR). Methods We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome. Results Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases. Conclusions In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea.
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Affiliation(s)
- Vu Thuy Duong
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Children’s Hospital 1, Ho Chi Minh City, Vietnam
| | - Ha Thanh Tuyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - Pham Van Minh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - James I Campbell
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | | | - Tran Do Hoang Nhu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - Le Thi Phuong Tu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Tran Thi Hong Chau
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
| | - Le Thi Quynh Nhi
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- University of Medicine and Pharmacy at Ho Chi Minh City
| | | | | | | | - Lu Lan Vi
- The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Corinne N Thompson
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
| | - Guy E Thwaites
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
| | - Ruklanthi de Alwis
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University
- The Department of Medicine, University of Cambridge, United Kingdom
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Sabouri M, Mahabadi A, Tabesh H, Rezvani M, Kouchekzadeh M, Namazi A. Epidemiologic and Demographic Features, Therapeutic Intervention and Prognosis of the Patients with Cerebral Aneurysm. Adv Biomed Res 2018; 7:6. [PMID: 29456977 PMCID: PMC5812090 DOI: 10.4103/abr.abr_77_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cerebral aneurysms are a kind of cardiovascular diseases which are accompanied with high morbidity and mortality due to rupturing and causing subarachnoid hemorrhages. The current study aimed to determine epidemiologic and demographic features and prognosis of patients with cerebral aneurysms. MATERIALS AND METHODS In this cross-sectional study, 465 patients with cerebral aneurysms hospitalized in Al-Zahra Hospital were studied. The required information including demographic, epidemiologic, and clinical features of the disease were extracted from their records. The obtained data were analyzed using SPSS software and the factors associated with the prognosis of the disease were determined. RESULTS Four hundred and sixty-five cases with cerebral aneurysm undergoing surgery were investigated. The mean age of the patients was 48 ± 14 years whereas 216 cases (46.5%) were male and 249 (53.5%) were female. Two hundred and thirty-seven patients (51%) remitted completely while the disease caused moderate disability in 84 cases (18.1%), severe disability in 24 ones (5.2%) and vegetative state in 9 cases (1.9%) and mortality in 57 ones while it was unknown in 54 cases (11.6%). In terms of the age of patient, WFNS index, anatomical position of aneurysm, type of aneurysm lesion, the incidence season of the disease, type of postoperative complications, family history and operative approach, the disease outcome had a significant difference while gender, ethnicity, and risk factors had no significant effect on the disease outcome. CONCLUSIONS According to the type of aneurysm, the incidence position of the aneurysm and other epidemiologic, demographic, and clinical features, providing the prevention and treatment strategies is necessary.
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Affiliation(s)
- Masih Sabouri
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Mahabadi
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homayoun Tabesh
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majeed Rezvani
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masih Kouchekzadeh
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Namazi
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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49
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Arora U, Ananthakrishnan AN, Kedia S, Bopanna S, Mouli PV, Yadav DP, Makharia GK, Yajnik V, Ahuja V. Effect of oral tobacco use and smoking on outcomes of Crohn's disease in India. J Gastroenterol Hepatol 2018; 33:134-140. [PMID: 28475826 DOI: 10.1111/jgh.13815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/24/2017] [Accepted: 05/02/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Smoking has been linked with adverse outcomes in Crohn's disease (CD); however, it is not known whether oral tobacco (OT) use affects disease outcomes in these patients. The study aimed to assess the association between smoking or OT and outcomes in CD. METHODS Retrospective analysis was performed on prospectively maintained records of CD patients from 2004 to 2016. The parameters assessed included disease characteristics at baseline (location, behavior, age at onset, perianal disease, and extraintestinal manifestations), course pattern, and outcomes (surgery, hospitalizations, immunomodulator or biologics use, and steroid requirement). RESULTS A total of 426 patients were included (mean age: 39.9 years; 59.9% men; median follow up: 71 months). Forty patients were ever-OT users, and 59 were ever-smokers, ever-use being defined as daily use for at least 2 years. OT use was associated with male sex and smoking. Both OT use and smoking had no effect on baseline characteristics, but upper gastrointestinal disease was less common in ever-smokers. Both OT use and smoking did not have any effect on surgery, immunomodulator, and biologic use. Similarly, no association was found between these outcomes and duration, daily, and cumulative exposure to tobacco. Current but not former tobacco use in both smoked (adjusted odds ratio = 2.59 [1.22-5.49]) and OT (adjusted odds ratio = 2.97 [1.03-8.6]) forms increased risk of hospitalizations. CONCLUSION Oral tobacco use and smoking had no significant detrimental effect on disease phenotype or medical and surgical requirements in CD in Indian patients, affirming other non-Caucasian studies that found lack of effect of smoking. However, current tobacco use in any form was associated with hospitalization during follow up.
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Affiliation(s)
- Umang Arora
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sawan Bopanna
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pratap Venigalla Mouli
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Dawesh P Yadav
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Govind K Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Yajnik
- Massaschusetts General Hospital Crohn's and Colitis Center, Boston, Massachusetts, USA
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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50
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Koning AM, Meijers WC, Minović I, Post A, Feelisch M, Pasch A, Leuvenink HGD, de Boer RA, Bakker SJL, van Goor H. The fate of sulfate in chronic heart failure. Am J Physiol Heart Circ Physiol 2016; 312:H415-H421. [PMID: 27923792 DOI: 10.1152/ajpheart.00645.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 10/24/2016] [Accepted: 11/26/2016] [Indexed: 11/22/2022]
Abstract
New leads to advance our understanding of heart failure (HF) pathophysiology are urgently needed. Previous studies have linked urinary sulfate excretion to a favorable cardiovascular risk profile. Sulfate is not only the end product of hydrogen sulfide metabolism but is also directly involved in various (patho)physiological processes, provoking scientific interest in its renal handling. This study investigates sulfate clearance in chronic HF (CHF) patients and healthy individuals and considers its relationship with disease outcome. Parameters related to renal sulfate handling were determined in and compared between 96 previously characterized CHF patients and sex-matched healthy individuals. Among patients, sulfate clearance was analyzed for associations with clinical and outcome parameters. In CHF patients, plasma sulfate concentrations are significantly higher, whereas 24-h urinary excretion, fractional excretion, and clearance of sulfate are significantly lower, compared with healthy individuals. Among patients, sulfate clearance is independently associated with diuretics use, creatinine clearance and 24-h urinary sodium excretion. Sulfate clearance is associated with favorable disease outcome [hazard ratio per SD increase 0.38 (95% confidence interval 0.23-0.63), P < 0.001]. Although significance was lost after adjustment for creatinine clearance, the decrease of sulfate clearance in patients is independent of this parameter, indicating that sulfate clearance is not merely a reflection of renal function. This exploratory study reveals aberrant sulfate clearance as a potential contributor to CHF pathophysiology, with reduced levels in patients and a positive association with favorable disease outcome. Further research is needed to unravel the nature of its involvement and to determine its potential as a biomarker and target for therapy.NEW & NOTEWORTHY Sulfate clearance is decreased in chronic heart failure patients compared with healthy individuals. Among patients, sulfate clearance is positively associated with favorable disease outcome, i.e., a decreased rehospitalization rate and increased patient survival. Hence, decreased sulfate clearance may be involved in the pathophysiology of heart failure.
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Affiliation(s)
- Anne M Koning
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidor Minović
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adrian Post
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martin Feelisch
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Biomedical Research Centre, Southampton, United Kingdom; and
| | - Andreas Pasch
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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